| [Background]How to repair soft tissue defect with high quality, efficiency and economic become a research focus in plastic surgery field. The traditional methods were still no effective cure for those patients who had severe soft tissue injuries. Negative pressure wound therapy (NPWT) has been widely used repairing various acute or chronic wound for clinical application of 20 years. But the researchers also found that NPWT has still some deficiencies in the repairing soft tissue defect, for example, insufficient ability of wound cleaning, and low reliability after a long-term using. Some scholars suggested that Negative Pressure Wound Therapy with instillation (NPWTi) could make up the insufficiency of NPWT. However, NPWTi has not been widely in clinical treatment as a new method for repairing soft tissue defect.The aim of this study is to investigate roles of NPWTi on efficiency of cleaning the wounds, pathophysiological outcomes of injured tissues at early stage and quantitative change of bacterial load. The objective was based on a design-new wound treatment device with active perfusion & aspiration function and establishment of standardized soft tissue defect on porcine model.The results of study offer reference for repair soft tissue defect with high quality, efficiency and economic.[Object](1) To develop a device for automated active wound instillation and negative pressure therapy(2) To develop soft tissue defect on porcine model.(3) To explore the efficacy of cleaning wound by NPWTi.(4) To explore the effect of vascular proliferation on granulation tissues by NPWTi at early stage.(5) To explore the effect of wound inflammation degree by NPWTi at early stage.(6) To explore the effect of collagen deposition by NPWTi at early stage.[Method](1) By micro electronic control technology and the central controller to coordinate a vacuum pump and a peristaltic pump work, to develop negative pressure wound therapy function active perfusion device.(2) Selecting pig as experimental animal and scapular region and buttocks as the experimental area, and taking the partial excision of skin and a heavy object combination method to make standard pig-soft-tissue damage model. T-test was used to measure different tissue about the impact pressure, the wound area, volume and depth of the soft tissue defect, macrophage, neutrophil and lymphocyte number and wound tissue Caspase-3 level in order to evaluate the consistency of soft tissue defect.(3) Using wound coating graphite particles to prepare soft tissue injury wound contaminated model based on the standard pig-soft-tissue damage model. Then using gauze to cover the treatment method, NPWT and NPWTi removed wound foreign body. Tissue contamination rates were comparison of from before treatment, after treatment, 1-hour,2-hour and 3-hour respectively.(4) Using Gauze?NPWT and NPWTi to treat wound based on the standard pig-soft-tissue damage model. Tissue samples were obtained from before treatment, after treatment 1-days,3-days,5-days and 7-days respectively. Repeated measures and variance analysis were compare to wound the level of VEGF and HIFl-a, in order to explore the effect of early application of NPWTi for vessel proliferation of wound granulation tissue.(5) Using Gauze?NPWT and NPWTi to treat wound based on the standard pig-soft-tissue damage model. Tissue samples were obtained from before treatment, after treatment 1-days,3-days,5-days and 7-days respectively. Variance analysis were compare to wound the number of tissue macrophages neutrophils and lymphocytes, wound bacterial load and the level of TNF-a, IL-6, in order to explore the effect of early application of NPWTi for wound inflammation levels.(6) Using Gauze?NPWT and NPWTi to treat wound based on the standard pig-soft-tissue damage model. Tissue samples were obtained from before treatment, after treatment 1-days,3-days,5-days and 7-days respectively. Variance analysis were compare to Hyp, collagen type I and type III levels in order to explore the effect of early application of NPWTi for collagen deposition.[Result](1) Develop negative pressure wound therapy function active perfusion device.The function of device includes active wound perfusion-negative, negative pressure wound therapy and wound irrigation. It can be automatically performed function transformation about wound perfusion and negative pressure of wound.(2) Caspase-3 were shown in different parts of standard pig-soft-tissue damage model. Soft tissue defects, volume, pressure, tissue macrophages, neutrophils and lymphocytes, and Caspase-3 were no statistically significant differences in expression levels (P>0.05).(3) The study using Gauze, NPWT and NPWTi at different time to remove wound foreign body have shown that there were statistically significant (P<0.05) in three groups.(4) The study using Gauze, NPWT and NPWTi to affect early vessel proliferation of wound granulation tissue have shown that there were statistically significant differences in expression level of HIF1-? and VEGF in three groups (P<0.05). There were statistically significant differences between expression level of HIF1-? and VEGF and treatment methods at different time.(5) The study using Gauze, NPWT and NPWTi to affect early wound inflammation levels have shown that there were statistically significant differences in expression level of tissue macrophages neutrophils and lymphocytes, wound bacterial load and the level of TNF-a, IL-6 in three groups (P<0.05). There were statistically significant differences between expression level of tissue macrophages neutrophils and lymphocytes, wound bacterial load and the level of TNF-a, IL-6 and treatment methods at different time (P<0.05).(6) The study using Gauze, NPWT and NPWTi to affect collagen deposition have shown that there were statistically significant differences in expression level of Hyp, collagen type I and type III levels in three groups (P<0.05). There were statistically significant differences between expression level of Hyp, collagen type I and type III levels and treatment methods at different time (P<0.05).[Conclusion](1) In contrast to the Gauze group and NPWT group, NPWTi can effectively remove foreign matters in wound.(2) In contrast to the Gauze group and NPWT group, NPWTi can accelerate angiogenesis in granulation tissue of wound level at early application.(3) In contrast to the Gauze group and NPWT group, NPWTi can significantly reduce the level of inflammation in wound tissue at early application.(4) In contrast to the Gauze group and NPWT group, NPWTi can accelerate the collagen deposition level wound granulation tissue at early application. |
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