The Clinical And Basic Research About Bilayered Negative Pressure Wound Therapy For Treatment Of Postoperative Lymphorrhagia

[Background]Lymphorrhagia is lymph node dissection the common postoperative complications, the risk of a large number of fluid loss, delayed wound healing, infection and skin flap necrosis, hypoalbuminemia, electrolyte disorder, etc. Specification of surgery operation is difficult to completely avoid the happening of Lymphorrhagia. The main cause of lymphatic leakage lymphatic lack of spontaneous sealing mechanism, cleaning the postoperative residual dead space, die cavity effusion, contain in the lymph is rich in protein, under the long-term stimulation of lymph, dead space capsule wall fibrosis, the chronic wound. It is lack of a kind of for lymphatic leakage prevention and treatment of recognized the most effective method. NPWT Is a rise in nearly 20 years of clinical treatment of chronic wounds of important technology. Currently used for the treatment and prevention of all kinds of postoperative incision at risk, in 2013, Robert Tauber first reported the NPWT in the prevention of postoperative complications of inguinal lymph node dissection applications.[Purposes]Evaluate bilayered negative pressure wound therapy the sweeping lymphatic leakage prevention and treatment of postoperative effect, and discusses from two aspects of physics and molecular biology to analyze its mechanism.[Methods]The first part of the bilayered negative pressure wound therapy promote the healing of the role of molecular biology:rabbit back flap model, after 48 hours, respectively, was made in the application of NPWT group, conventional adjuvant treatment group, blank control group of rabbit skin flap tissue and blood samples, with HE staining and immunohistochemical respectively to observe the flap healing of angiogenesis and fluorescence quantitative PCR, respectively in the organization Hif-1 alpha, VEGF, Bax, Caspase 3 in the content of negative pressure group and conventional treatment group, analysis the rule.The second part of the experimental content is physics of bNPWT:imaging experiments: using fresh pig skin flap model, thin tube flap under lien, by using the method of contrast agent injection lymph leakage seepage simulation:1, the application of CT three dimensional reconstruction method to observe the contrast agent injection double negative pressure closed attract attract and simply work mode.2, injection of contrast agent in advance 10 ml,0 s in different time points,10 min,20 min to dynamic observation of two kinds of treatment methods for the removal of the contrast agents, mechanics experiment: make the pig back flap model,1, flap placed under 40 mmHg,80 mmHg,125 mmHg,160 mmHg,200 mmHg negative pressure value, pressure sensors in, flap surface,0.5 cm,1.0 cm,1.5 cm,2.0 cm,2.5cm,3.0cm=2. determination of gauze thickness is 5 mm,8 mm,10 mm,15 mm,20 mm,125 MMHG negative pressure value.The third part of the clinical research section 2012.10-2014.10 lymphatic leakage cases a total of 24 cases,10 cases of incipient lymphatic leakage, to observe treatment effects, and the healing time.14 for chronic lymphatic leakage cases, application of the bnpwt combined with ultrasound guided by fiber cyst scraping, to observe the treatment effect and time.2012.10-2014.10 breast cancer prevention group cases:13 cases postoperatively, inguinal lymph node cleaning in 11 cases using bnpwt to observe real-time application incision healing and complications.[Results]1.48 hours after flap vascularized b-NPWT group, compared with the conventional Hif-1 alpha, VEGF levels higher than the conventional treatment group, Bax, Caspase 3 levels lower than the conventional treatment group.2. B-NPWT work is to establish efficient drainage channel, contrast agent residue, after 60 s drainage effect is stronger than the pure attract. Under the condition of the same negative pressure value, flap under pressure to rise, with negative pressure value increasing decreases as the thickness of skin flap to reduce. Under the condition of the same negative pressure, under the flap with the pressure increases with increasing the thickness of the dressing, to a certain thickness, increasing the thickness of dressings do not cause the change of pressure.3.B-NPWT have obvious effect on lymph leakage prevention, early lymphatic leakage and the treatment of chronic lymphatic[Conclusions]Bilayered negative pressure wound therapy has effective for post-operative lymphorrhagia treatment.