摘要目的 探讨VSD技术在四肢严重坏死性筋膜炎患者治疗中的应用效果. 方法 2011年1月-2013年8月,笔者单位收治8例在外院经传统碘伏纱布换药治疗21 ～365 d,均因创面迁延不愈并出现感染扩散致全身中毒症状而转入的四肢严重坏死性筋膜炎患者.入院后予及时清创,取患处坏死组织行HE染色后观察形态.术后行负压为-100～-80 kPa VSD治疗,同时经冲洗管持续滴入0.2 g/L呋喃西林溶液并经充氧管持续灌注氧气(2 L/min).根据创面清洁程度反复行清创术并更换VSD材料继续行VSD治疗,待创面新鲜后拉拢缝合或移植自体皮封闭.记录清创术次数、VSD材料更换次数、创面愈合情况、本院治疗时间,另进行远期随访. 结果 HE染色显示患处坏死组织中广泛脂肪、纤维结缔组织弥漫性坏死,正常组织结构消失,伴有大量炎性细胞浸润.清创术次数为2～10(3.9±2.8)次,VSD材料更换次数为2～ 10(4.0±2.9)次.2例患者创面缝合痊愈;6例患者创面部分缝合,残余创面经自体皮移植封闭.本院治疗时间为20 ～49(33±10)d,患者均痊愈出院.随访2 ～ 24个月,患者患处情况好、无溃破,均未复发坏死性筋膜炎. 结论 VSD技术能持续有效地清除筋膜间隙坏死组织和渗液,促进肉芽组织增生,是临床治疗四肢严重坏死性筋膜炎的有效措施.

abstractsObjective To study the application of VSD in the treatment of severe necrotizing fasciitis in extremities of patients.Methods Eight patients,suffering from severe necrotizing fasciitis,who had been traditionally treated with iodophor-soaked gauze for 21 to 365 days in other hospitals,were transferred to our institute because of the nonhealing wounds and systemic toxic symptoms induced by infection,from January 2011 to August 2013.After admission,surgical debridement was performed timely,and the necrotic tissue was collected during the operation for pathological observation after HE staining.After the operation,VSD was started with negative pressure ranging from-100 to-80 kPa,and the furacilin solution (0.2 g/L) and oxygen (2 L/min) were continuously infused into the wound during the treatment.Surgical debridement was performed repeatedly according to the wound condition followed by change of VSD dressings to continue VSD treatment.The wounds were closed by suturing or with autologous skin grafts after being covered by fresh granulation tissue.The times of surgical debridement,times of change of VSD materials,wound healing status,and length of stay in our institute were recorded.All patients were followed up for a long time.Results HE staining showed that there were diffuse necrotic adipose and fibrous connective tissues in the necrotic tissue,and the normal tissue structure disappeared accompanied by significant infiltration of inflammatory cells.The number of surgical debridement was 2 to 10 (3.9 ± 2.8) times.The number of VSD materials change was 2 to 10 (4.0 ± 2.9) times.Wounds were closed by suturing and healed in two patients; wounds in the other six patients were partially sutured,their residual wounds were healed by autologous skin grafting.The length of stay in our institute was 20 to 49 (33 ± 10) days.All patients were discharged after recovery.Patients were followed up for 2 to 24 months,and their wounds were found to be in good condition without ulceration or recurrence.Conclusions VSD can effectively remove the necrotic tissues and exudates from the fascial spaces and promote proliferation of granulation tissue.Therefore it serves as an effective approach to the treatment of severe necrotizing fasciitis in extremities.