Clinical Effect Research On Assist Local Skin Flap To Repair The Pressure Ulcers By PU-VSD

BACKGROUNDPressure sores, also known as the bedsore, it cause of the compression acting on the local tissue for a long time, local continuous ischemia, hypoxia, blood circulation obstacle, malnutrition and soft tissue damage and necrosis. Pressure sores caused by pressure that the most basic and the most important factor, we tend to think of pressure sores renamed the "pressure ulcers" at present. It common happen in paralysis and bedridden patients. Malnutrition, older than 70 years old, weak, Fecal and urinary incontinence, and the patients with a plaster cast are at higher risk, pressure sores usually happen in the position that lack of adipose tissue protection and no muscle or muscle layer thinner bone juga place, and have close relationship with recumbent. It occurs in head, shoulder, elbow, sacral tail, heel at the horizontal position; Cheek, shoulder, knees and toes at the prone position; Ear, shoulder, hip and knee inside and outside and inside the external ankle at the lateral position. The new definition of pressure ulcers comefrom NPUAP in 2007:the suspicious damage of deep skin tissue and subcutaneous tissue, cause for the pressure or the composite shear force effect. Local skin integrity but can appear color change such as purple or maroon, blisters or cause congestion. Pressure sores be divided into 4 degrees:I degrees:Skin without damage, just skin redness, or the skin redness, and surrounding skin well, pressure of not fade, often confined to the apophysis. II degrees:Part of the cortex damaged,Damaged part of the skin, superficial skin ulcer, basal red, no scabby, also be complete or break bleeding blister. III degrees:. Full-thickness skin loss or Full-thickness skin missing, but muscle, tendon and bone has not been exposed, often appear scabby, subcutaneous tunnel. IV degrees:Full thickness tissue loss, Full-thickness skin loss with muscles, tendons, and bone exposure, usually have scabby and subcutaneous tunnel, unclassification:full-thickness skin and organization lack, the bottom of the ulcer was rotten meat and/or eschar completely covered, Real depth of the wound will be judged after clearing the rotten meat or the eschar. With the improvement of life expectancy, the incidence of pressure ulcers increases year by year. Clinically, it is the most common hip position happened in the ischial tuberosity, at the end of the sacral femoral and greater trochanter. Hip pressure ulcers as a refractory disease to patients1 pain, not only affect the quality of life, but also bring heavy burden of economy and society to the patients and family, and The more serious is system infection that can endanger patient’s life. The treatment of pressure sores are diverse, such as traditional treatment therapy、Chinese medicine plaster stick take therapy 、 the treatment of stem cells and cytokines, all this methods can be found in the modern clinical activities. For self-healing of the moderately severe hip pressure sores is poor, hip flap used to repair the wound. Hip have a surplus of soft tissue and larger mobile, different skin flap can be chosen to use in repairing the wound, such as glutaeus maximus myocutaneous flap, the nutrient vessels of the posterior antebrachial cutaneous nerve flap stocks, broad fascia myocutaneous flap and various forms of fascia flap and so on. Postoperative, bind up and fix the wound with pads, gauze bandage. However, Postoperative nursing is difficulties, "Move" and "fixed" is the contradiction in nursing, patients with pressure ulcers requires turn 1 at every 2 hours, frequent replacement of decubitus position make the wound dressing easyly to loose. So the once operation success rate of skin flap is not high, Common complications such as wound dehiscence, base not adhesion. The reason is that repeatedly body position change let bandage loose, lose binding effect; Turn over the operation area and the surrounding tissue shear force caused by relative motion affect wound healing; Different decubitus position hip organization because of the action of gravity and the friction cause wound tension increases, cracked. Some hospitals postoperative nursing with roll over bed has good effect, but applications are emancipated bed time-consuming, care burden, interference of the patients with big, too. Other Some hospitals postoperative nursing with suspended bed, it can get the Organization out of being pressed, Patients needn’t to move, but the cost is too expensive, There is not in ordinary hospital. Clinical applications need a simple, inexpensive method, it can solve the contradiction of" Move " and "fixed" contradiction, and improve the once operation success rate,negative pressure Wound therapy(NPWT) is a way to accelerate the wound healing, There are more than 20 years of clinical application, with polyvinyl alcohol hydration algae salt containing the drainage tube foam dressings, to cover or fill the skin and soft tissue defect wound, reoccupy biological membrane to closed, makes it a confined space, finally the drainage tube through negative pressure source, through to control the negative pressure to be an Efficient drainage system, the PU (Polyurethane) and PVA (Polyyinyl alcohol) are the two main kinds medical sponge that used in NPWT. With polyurethane as the negative pressure material technology, called PU-VSD, with polyvinyl acetate as negative pressure material technology, called PVA-VSD. PU has Biological good intermiscibility, non-toxic and no stimulation, breathable waterproof performance is good, not dry harden, widely used in foreign countries. PVA With a lot of each other mutually, diameter of 0.2 mm to 0.2 mm gap,it has a strong adsorption characteristics of the body secretions. It’s disadvantages is that it can becom dry harden after water loss. PVA-VSD is widely applied in our country, using it’s active and powerful drainage effect. Drainage technology are constantly improve, the third generation has intermittent low negative pressure+double pressure control display+smart exclusion+the closed automatic flushing function of the wound the VSD has been used in the large soft tissue defect of incision drainage、 articular cavity infection、 acute or chronic osteomyelitis window drainage、wound infection after the operation 、 diabetic foot、 pressure sores 、 refractory wounds, and so on.Experimental study on the mechanisms of improve wound repair by VSD techniques:(1) increase wound microcirculation blood flow velocity, expand the capillaries, thus increasing the flow of blood to the wound; (2) attract wound exudate in time, remove the necrotic tissue, relieve the edema of wounds; (3) closed wet environment inhibiting bacteria breeding, to prevent the pollution and infection. (4) the stretch of the machinery, mechanical stress induced the growing of cell.point 3 shows the VSD has wound dressing effect, mechanical stretch and let the VSD with fixed function were shown in point 4. Bandaging and fixation is an important part of operation, the appropriate or not, can directly affect the success of surgery. Such as skin grafting, binding inappropriate and skin cannot establish blood supply with basal organization causes skin cannot survive, surgery failure. The VSD negative pressure formed after mechanical stretch and make dressing area and the skin around the fixed into a whole.This change with the position change as a whole, but the inside of the organization is not shift. Because of the characteristics of the material, PVAlost water become dry and as hard as gypsum, not suitable for use on the surface of the skin. PU-VSD is only suitable for dressing and fixed, external polyurethane material is very cheap. Some scholars use the skin grafts after VSD pressurized fixed, found that can improve the survival rate of flap.other scholars applicate VSD in the postoperative period of flap, found that can promote the skin flap survival.The contradiction of "move" and "fixed" Postoperative hip pressure sores flap, can be narrowed to the contradiction of "move" and "fixed" the incision surrounding tissue hip. Postoperative period using PU-VSD fixed flap surrounding tissues is a feasible solution. Negative pressure formed after fixed flap surrounding tissue to form a whole, will not shift due to roll over. With PU-fixed after VSD can improve the once operation success rate of the hip flap and to reduce complications? This study was to explore the PU-local skin flap to repair the VSD auxiliary hip pressure sores existing advantages, evaluate the value in clinical application.OBJECTIVES1^ To explore the pulling change of incision about the patient position change when hip skin flap and the organization fixed by PU-VSD moved as a whole.2^ To observe the Clinical effect in assist local skin flap to repair the pressure ulcers by PU-VSDMaterial and MethodMaterial:Medical polyurethane sponge (Creat health company in Shan Dong); Medical sputum suction tube; Biological semi-permeable membrane (Smith & Nephew Medical Ltd) and adjustable negative pressure source (Tianjin the second medical instrument factory). Yarn block, pads, bandage.Methodl:From 2013, in our department15 patients with hip skin without damage as a volunteer. Draw a vertical line on the coccyx gluteal 8 cm in Prone position, Mark two points on both sides of the intersection point, the distance is 18 cm. Measure each volunteer the linear distance between two points marked before the application of PU-VSD, after PU-VSD applies for 2 hours in the stand, under the left side and right side. Compared the linear distance of two marked points in the stand, under the left side and right side with prone position, difference calculation. Compared the difference before the fixed position and after.Method2:From August 2012 to December 2014,The patients with IV degree Pressure sores at hip would be done the operation of local skin flap to repair the pressure sores, they were divided into 2 groups with randomized and double-blind. Preoperative routine therapy, intraoperative flap design, leading doctors with deputy director of the physician are the same one.16 cases of observation Group after operation used PU-VSD auxiliary fixed on the flap surface; 18 cases of the control group, incision built-in sterile gauze piece, use pads bandage fixation. Those patients who can activate independent would not limite the bed activates, the patients who were restricted movement, would be turn over once every 2 hours by professional attendants. The VSD continuous negative pressure attraction in observation group, found a flat and deal with in time. Control group was replaced pollution dressings and fixed again loose dressing in a timely manner. once operation successful cases will be found in this two groups after Five days, find the reason of complications and deal with the complications. Observation group continue to use PU-VSD auxiliary fixed 1 week, take out incision stitches after 2 weeks. Control group to continue pads bandage fixing, the split incision will be sutured together again. Compare the one operation success rate、complication rate of two groups, compare the wound healing time and hospital stays after Wound healing.Statistical analysis:Analyze the inputed data by SPSS 16.0 statistical software, count data was express by rate, measurement data mean was express by standard deviation, when t test, P< 0.05, the different has statistically significant.RESULTS:1、 The measured values between 2 points marked on the surface of hip are different in different postures. The measured values hardly change after PU-VSD on the surface of hip, the difference in 1 cm. The measured values between two points (compared with prone position) change obviously than applying PU-VSD in the stand, under the left side and right side, P< 0.05 was statistically significant.2、The comparison of once surgical success rate and complications between two groups in the fifth day after operatiion:the rate of once surgical success in observation group is 93.75%, the rate of once surgical success in control group is 61.11%, there are statistical significance (P< 0.05) in the comparison between two groups.16 cases of Observation group has complications in 1 case, surgery again after control the infection.6 of 18 case in control group has complications, need to surgery again,1 case with infection,3 cases with split,2 cases with basal not adhesion. The complication rate of two groups of comparison, the difference was statistically significant (P< 0.05). The comparison of healing time、 length of hospital stay in this two groups after Wound healing:The wound healing time and the length of time significantly in the Observation group was shorter than the control group, the difference has statistically significant (P< 0.05).Conclusion:1、 When hip skin and the organization fixed by PU-VSD moved as a whole, the pulling force of skin was reduced about the position change.2% PU-VSD was used in the hip flap after operation can significantly improve the success rate and reduce postoperative complications, shorten the wound healing time and hospital stay, is worth to popularize in clinical.