Department of Plastic and Hand Surgery, University of Freiburg Medical Centre, Hugstetter Strasse 55, 79106 Freiburg, Germany.
J Plast Reconstr Aesthet Surg. 2012 May;65(5):640-9. doi: 10.1016/j.bjps.2011.11.037. Epub 2011 Dec 3.
We recently established negative pressure wound therapy (NPWT) as a safe postoperative care concept for free muscle flaps; however, the molecular effects of NPWT on free muscle flaps remain elusive. Here we investigated the effects of NPWT on pathological changes associated with ischaemia/reperfusion injury in free flap tissue.
From July 2008 to September 2010, 30 patients receiving skin-grafted free muscle transfer for defect coverage were randomly assigned to two treatment groups: In one group the skin-grafted free flap was covered by a vacuum dressing (NPWT); in the second group, flaps were covered by conventional petroleum gauze dressings (conv). Biopsies were taken intra-operatively prior to clipping of the pedicle and on postoperative day 5. Samples were analysed by immunohistochemistry for infiltration of inflammatory cells, real-time polymerase chain reaction (RT-PCR) for the analysis of expression levels of interleukin-1β (IL-1β) and tumour necrosis factor (TNF)-alpha as markers of inflammation. Histological samples were also examined for interstitial oedema formation, and apoptosis was detected by a terminal deoxynucleotidyl transferase dUTP nick end labelling (TUNEL) assay.
NPWT leads to a significantly reduced tissue infiltration of CD68 + macrophages and reduced expression of the inflammatory cytokines IL-1β and TNFα. None of these parameters was significantly elevated in the pre-ischaemic biopsies. Furthermore, NPWT reduced the interstitial oedema formation and the number of apoptotic cells in free flap tissue.
NPWT of skin-grafted free muscle flaps leads to a reduced inflammatory response following ischaemia/reperfusion, resulting in reduced oedema formation improving the microcirculation and ultimately reduced tissue damage. We thereby deliver new insight into the effects of NPWT.
我们最近将负压伤口治疗（NPWT）确立为游离肌肉皮瓣安全的术后护理理念；然而，NPWT 对游离肌肉皮瓣的分子影响仍不清楚。在这里，我们研究了 NPWT 对游离皮瓣组织缺血再灌注损伤相关病理变化的影响。
2008 年 7 月至 2010 年 9 月，30 例接受游离皮瓣移植修复缺损的患者被随机分为两组：一组皮瓣覆盖负压敷料（NPWT）；另一组皮瓣覆盖常规凡士林纱布（conv）。在夹闭蒂部前和术后第 5 天分别取皮瓣组织进行活检。通过免疫组织化学分析浸润的炎症细胞，实时聚合酶链反应（RT-PCR）分析白细胞介素-1β（IL-1β）和肿瘤坏死因子（TNF）-α的表达水平，作为炎症标志物。组织学样本还检测了间质水肿的形成，末端脱氧核苷酸转移酶 dUTP 缺口末端标记（TUNEL）检测法检测了细胞凋亡。
NPWT 导致 CD68+巨噬细胞的组织浸润显著减少，炎症细胞因子 IL-1β和 TNFα的表达降低。缺血前活检中这些参数均无显著升高。此外，NPWT 减少了游离皮瓣组织的间质水肿和凋亡细胞的数量。
NPWT 可减轻游离肌肉皮瓣缺血再灌注后的炎症反应，减少水肿形成，改善微循环，最终减少组织损伤。我们为此提供了 NPWT 作用的新见解。
