【摘要】 目的：研究負压引流（VSD）联合游离皮瓣移植治疗创伤性大面积软组织缺损的临床效果。方法：选取2013年1月-2020年10月本院收治的60例创伤性大面积软组织缺损患者为研究对象，随机将其分为对照组（n=30）和研究组（n=30），对照组采用常规处理+游离皮瓣移植，研究组采用VSD+游离皮瓣移植。比较两组肉芽生长时间、创面愈合时间、皮瓣吻合及存活情况，以及治疗前后的创面综合情况、血清炎症指标水平。结果：研究组治疗后2周VEGF、血流灌注量及bFGF水平均明显高于对照组，血清TNF-α、CRP、IL-6、IL-8水平均明显低于对照组（P<0.05）。研究组肉芽生长及创面愈合时间均明显短于对照组，皮瓣吻合率、皮瓣总存活率均明显高于对照组（P<0.05）。结论：VSD联合游离皮瓣移植术应用于创伤性大面积软组织缺损患者，使得创面的血管内皮生长因子和血液灌注量明显增多，还可以降低患者血清各项炎症指标水平，同时促进肉芽组织生长和创面愈合，最终有效提高皮瓣存活率。

【关键词】 VSD 游离皮瓣移植术 大面积创伤 软组织修复

Study on the Repair Effect of VSD Combined with Free Flap Transplantation on Traumatic Large-area Soft Tissue Defect/LIN Chuandong. //Medical Innovation of China， 2021， 18（34）： 0-085

[Abstract] Objective： To study the clinical effect of vacuum sealing drainage （VSD） combined with free flap transplantation in the treatment of traumatic large-area soft tissue defect. Method： A total of 60 patients with traumatic large-area soft tissue defect admitted to our hospital between January 2013 to October 2020 were selected as the research objects， they were randomly divided into the control group （n=30） and the study group （n=30）. The control group was treated with routine treatment + free flap transplantation， and the study group was treated with VSD + free flap transplantation. The granulation growth time， wound healing time， flap anastomosis and survival were compared between the two groups， and the wound comprehensive situation and serum inflammatory index levels before and after treatment were compared. Result： 2 weeks after treatment， VEGF， blood perfusion and bFGF levels of the study group were significantly higher than those of the control group， serum TNF-α， CRP， IL-6 and IL-8 levels were significantly lower than those of the control group （P<0.05）. The granulation growth and wound healing time of the study group were significantly shorter than those of the control group， and the flap anastomosis rate and total flap survival rate were significantly higher than those of the control group （P<0.05）. Conclusion： VSD combined with free flap transplantation is applied to patients with large traumatic soft tissue defects， which significantly increases the vascular endothelial growth factor and blood perfusion in the wound， and can also reduce the serum levels of various inflammatory indicators in the patient， while promoting granulation tissue growth and wound healing， and ultimately effectively improve the survival rate of the flap.

[Key words] VSD Free flap transplantation Large-area trauma Soft tissue repair

First-author’s address： Guangdong Yanling Hospital， Guangzhou 510000， China

doi：10.3969/j.issn.1674-4985.2021.34.019

创伤多因机械伤害、交通事故、高温寒冷等因素所致。其中软组织缺损多因暴力因素条件导致，受伤部位表现为疼痛、肿胀、功能障碍、出血等，部分患者可伴随败血症、呼吸及循环系统功能衰竭，严重危及患者生命安全[1]。部分患者因软组织缺损创面过大，加之机体炎症因子水平高，从而加大愈合难度[2]。既往，创伤性大面积缺损患者常采用常规处理加游离皮瓣移植，其虽可以修复软组织缺损，但其治疗周期较长，易伴并发症，最终治疗效果难以令人满意[3]。……