Objective To ohserve therapeutic effect of negative-pressure treatment combined with tissue transplantation on complicated and refractory wounds after debridement.Methods After debridement,20 patients with 20 complicated and refractory wounds hospitalized in our burn wards from May 2008 to June 2010 were randomly divided into treatment group (T,treated with negative-presaure from - 19 kPa to -8 kPa,n =10) and control group (C,covered with petrolatum gauze overlaid with saline gauze and dry gauze,n - 10) according to alternating method.On post treatment day (PTD) 4,7,and 14,granulation tissues of wound surface in size of 4 mm × 3 mm × 2 mm were harvested for histopathological observation ( including capillary growth,inflammatory cells,and collagen arrngement ) with HE staining,and the numbers of vascular endothelial cells ( VEC,with addition of rabbit anti-human coagulation factor Ⅷ related antigen polyclonal antibody ) and proliferation period cells (with addition of mouse anti-human Ki-67 monoclonal antibody) were counted by immunohistochemical staining.Data were proessed with t test.Another 59 patients harboring 62 complieated and refractory wounds admitted to our burn ward at the same period were treated with the same mode of debridement,negative-pressure therapy,followed by timely skin or skin flap grafting.Results (1) Granulation tissue in T group grew more rapidly than that in C group.More capillaries and less inflammatory cells were observed in T group on PTD 7 as compared with those in C group.Collagen in T group on PTD 14 was more regular in arrangement than that in C group.The number of VEC per 400 times visual field in T group on PTD 4,7,and 14 was respectively higher than that in C group ( 108.7 ± 11.2 vs.31.0±3.6,138.0±14.7 vs.34.6±4.5,68.7±6.9 vs.55.1 ±6.5,with t values from 4.62 to 30.28,P values all equal to 0.01 ).The number of proliferation period cell per 400 times visual field in T group on PTD4 and7 was respectively higher than that in C group (88.9 ±5.9 vs.16.6 ±3.3,128.1 ±13.0 vs.110.1 ± 8.9,with t value respectively 19.89,3.33,P values all below 0.05 ).The number of proliferation period cell per 400 times visual field in T group on PTD 14 was obviously lower than that in C group (26.7±5.1 vs.59.7 ±4.5,t =-12.43,P =0.01).(2) After being treated with above therapeutic mode,necrotic tissues were removed completely and granulation tissue grew rapidly in 62 complicated and refratory wounds with high survival rate of skin grafts or skin flaps with good repair effect. Conclusions Negative-pressure therapy can accelerate VEC formation and stimulate cell proliferation after debridenent.Debridement,negative-pressure therapy,and timely skins/skin flaps grafting can effectively increase healing rate of complicated and refractory wounds.%目的 观察清创术-负压治疗-组织移植模式对复杂、难愈性创面的临床疗效. 方法 选择2008年5月-2010年6月笔者单位收治的20例患者(共计20处复杂、难愈性创面),清创后按照交替法随机分为治疗组(负压治疗,- 19～-8 kPa)与对照组(凡士林纱布+生理盐水纱布+干纱布覆盖),每组10例.治疗4、7、14d切取4 mm×3 mm×2 mm创面肉芽组织进行HE染色,观察肉芽组织生长情况,包括毛细血管、炎性细胞数量及胺原纤维的排列；采用兔抗人凝血因子Ⅷ相关抗原多克隆抗体、鼠抗人Ki-67单克隆抗体进行免疫组织化学染色,计数血管内皮细胞和增殖期细胞.对数据进行t检验.在此基础上采用清创术-负压治疗(同前)-适时植皮(皮瓣)修复模式,治疗笔者单位同一时期收治的59例患者共计62处复杂、难愈性创面,观察疗效. 结果 (1)与对照组比较,治疗组治疗7d时毛细血管数量明显增多、炎性细胞少；治疗14 d,治疗组腔原排列较对照组规则.治疗组治疗4、7、14 d时血管内皮细胞计数分别为每400倍视野(108.7±11.2)、(138.0±14.7)、(68.7±6.9)个,明显高于对照组[(31.0±3.6)、(34.6±4.5)、(55.1±6.5)个,t值为4.62～30.28,P值均等于0.01].治疗组治疗4、7 d增殖期细胞计数分别为每400倍视野(88.9±5.9)、(128.1±13.0)个,明显高于对照组[(16.6±3.3)、(11.01±8.9)个,t值分别为19.89、3.33.P值均小于0.05],治疗组治疗14 d增殖期细胞计数为每400倍视野(26.7±5.1)个,明显低于对照组[(59.7±4.5)个,t=12 43,P =0.01].(2)经过上述模式治疗,62处复杂、难愈性创面坏死组织被彻底清除,肉芽组织生长快,皮片或皮瓣成活率高,创面修复教果好.结论 负压治疗能加速清创后组织血管内皮细胞生成,刺激细胞增殖.清创术-负压治疗-适时植皮(皮瓣)修复的模式能有效提高复杂、难愈性创面的愈合率.
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