Zhang Wen-Hao, Wu Qi, Ma Jun, Wang Jia-Han
Department of Burn Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China. E-mail: sdzhangwenhao @163.com.
Nan Fang Yi Ke Da Xue Xue Bao. 2015 Oct;35(10):1481-6.
To investigate the effect of closed vacuum drainage combined with heparin irrigation in the treatment of scald burns with seawater immersion in rabbits.
Twenty New Zealand rabbits were subjected to deep partial-thickness scald burns in 4 regions on the bilateral skin of the spine. The wounds were managed with common dressing (group A), common dressing after seawater immersion (group B), closed vacuum drainage after seawater immersion (group C), or closed vacuum drainage combined with heparin irrigation after seawater immersion (group D). Wound effusion and tissue necrosis were observed at 1, 3, 5 and 7 days after the burns. Tissue samples were collected from the wounds for HE staining and immunohistochemistry for VEGF and CD31, and the changes of capillary endothelial cells in the wound were observed using electron microscopy. The water content in the wound tissues was determined, and the wound healing rate was calculated after the injury.
Sea water immersion of the wound results in earlier onset of edema and more extensive tissue necrosis in the scalded rabbits. The mean necrotic area in groups C and D was smaller than that in group B early after the burns, and vacuum drainage promoted necrotic tissue elimination and accelerated wound healing. Early after the burns, water content in the tissues increased with time in all the groups and reached the highest level at 3 days, and was significantly lower in groups C and D than in group B. Pathologically, vascular endothelial cell damage at the wound site was worsened after seawater immersion. In group D, the basement membrane damage was milder and the endothelial cell membrane remained intact at the wound site, where new blood vessels occurred at 3 days after the burns, a time earlier than that in the other 3 groups with also the highest vascular density.
Closed vacuum drainage combined with heparin irrigation can relieve edema at the scald wound with seawater immersion, improve microcirculation, accelerate the removal of necrotic tissue, and promote the growth of new blood vessels.
探讨封闭式负压引流联合肝素冲洗对兔海水浸泡烫伤创面的治疗作用。
将20只新西兰兔脊柱两侧皮肤4个区域造成深Ⅱ度烫伤。创面分别采用普通换药（A组）、海水浸泡后普通换药（B组）、海水浸泡后封闭式负压引流（C组）、海水浸泡后封闭式负压引流联合肝素冲洗（D组）处理。于烫伤后1、3、5和7天观察创面渗液及组织坏死情况。取创面组织标本行HE染色及VEGF和CD31免疫组化检测，并用电子显微镜观察创面毛细血管内皮细胞变化。测定创面组织含水量，并计算伤后创面愈合率。
创面海水浸泡导致烫伤兔水肿出现早、组织坏死范围广。烫伤后早期C组和D组平均坏死面积小于B组，负压引流促进坏死组织清除，加速创面愈合。烫伤后早期，各组组织含水量均随时间增加，于3天达最高水平，C组和D组显著低于B组。病理检查显示，海水浸泡后创面血管内皮细胞损伤加重。D组创面基底膜损伤较轻，内皮细胞膜完整，烫伤后3天出现新生血管，较其他3组提前，且血管密度最高。
封闭式负压引流联合肝素冲洗可减轻海水浸泡烫伤创面水肿，改善微循环，加速坏死组织清除，促进新生血管生长。
