In short, the aim of treatment is to reduce VSD exudate, reducing the amount of bacteria, and close the wound, rather than promoting granulation tissue, so much use in acute, nsd infectious trauma, and abdominal surgical wounds, and KCI VAC mostly use in chronic wounds promote nsd the growth of granulation tissue, which uses the average pressure nsd of up -400mmHg, instead of KCI VAC's -125mmHg, use a smaller aperture foam, 200μm (60-270) vs. 500μm (400-600), granulation tissue and therefore relatively nsd do not go long, relatively less pain medication, but also because of greater nsd resistance, relatively large negative pressure is required, and finally dressing interval of about 14 days for once, and KCI VAC take 2-3 changed every day.
The following excerpt from Shandong Chong Kang this site http://medilogy.cn/gongsi.asp article, the difference VSD and KCI VAC very detailed description of the topic as "negative pressure wound therapy in the new development," but further The search may be found in 蒋琪霞 by Liu Wei Xu Qing Pang Li Xiaohua Medical Postgraduates 200 720 (6) of the "negative pressure wound therapy research progress of key technologies," nsd but could not find the original Cipian online at CEPS SoftBrands to, it can not be confirmed, tentatively let us learn something new attitude to appreciate this text:
Negative pressure wound therapy (negative pressure wound therapy, NPWT) in the last ten years the rise of a new type of method to accelerate wound healing in patients, and has been widely used in the treatment of a range of refractory wounds, including acute, chronic, infectious wounds. The Rise and Development of negative pressure wound therapy, we believe this technology is divided into two branches, the first one is the VSD technology (vacuum sealing drainage, VSD), in 1993 [1] by Fleischmann German surgeon Dr. Wim first proposed and applied to the prevention and treatment of wound infection. After several years of development, in 1997 there has been a second negative pressure nsd wound therapy, nsd that is, from the US Surgeon Argenta [2] advocacy vacuum-assisted closure (vacuum-assisted closure, VAC). Both use suction principle, but in terms of the method and scope is slightly different, in order to clarify the concept, guide the rational and effective clinical applications, are reviewed on both the application and its role in wound treatment follows.
1.1 VSD technology (vacuum sealing drainage, VSD) Application of Improved: VSD began in 1993 in Germany for limb trauma surgery wound drainage, the next few years to expand the application has been accepted and the medical profession in Europe and America [1,3,4], after the introduction of Professor 裘华德 [5] and improvements applied to orthopedics, abdominal surgery, gynecological surgery and after seven thousand cases of clinical nsd practice has proved that this technology nsd will not only improve the drainage effect, can significantly speed up the infection and infection lacunar closed wound healing, significantly reduce the application of antibiotics to effectively prevent the occurrence of cross infection, shorter hospital stays, reduce patient pain and reduce the workload of medical staff, but also for upper gastrointestinal leakage and Surgical treatment of severe pancreatitis to develop new ideas [6]. This technology is considered "traditional surgical drainage to make major improvements, there are unique advantages of the new drainage technology" [5], the basic idea is efficient drainage, prevent blocking the tube, in order to ensure there is enough suction drainage area The use of occlusive dressings to close the area, cut off from the outside world was draining traffic, this design thinking is a significant improvement over traditional drainage methods. Practice, first with foam wrap and more medical drainage tube side hole, and then pasting the film permeability (semipermeable membrane) outside the mouth closed drainage or wound drainage area, high negative nsd pressure source is turned on, the negative pressure value at 60kPa ( 450mmHg) above, on the formation of an efficient drainage system. Applied Research shows that [5,7,8] due to the high negative effect of a soft foam material through an agency, can make a negative pressure evenly distributed on the surface of the drainage area, which can effectively prevent the traditional negative When pressed drainage organ or tissue that may occur due to the drainage tube is drawn pipe blockage, hemorrhage, necrosis and other complications.
Research 1.2 Mechanism: VAD is an efficient drainage, reflected in the comprehensive, high vacuum is "zero accumulate" drainage area, which can be effective in preventing surgical site effusion, infection cavities to accelerate closure and healing wound infection . . Histological examination confirmed nsd VSD wound lymphocytic infiltration subsided quickly, appeared early proliferative phase of collagen synthesis, repair period can be seen in the synthesis of contractile fiber reinforced [7]. Recent studies have further demonstrated that this technology "can significantly improve blood flow to the wound, promote necrotic nsd tissue and bacterial clearance, can accelerate the growth of granulation tissue and repair nsd cell proliferation and angiogenesis. "[9].
1.3 Indications Study: Indications include severe when VSD original soft tissue nsd laceration and soft tissue defects; or open fractures may have been co-infection; compartment syndrome; articular infection who require incision and drainage; acute and chronic osteomyelitis fenestration who need [1]. In recent years, along with in-depth research and practice, has been extended to the surface abscess, pyogenic infections, chronic ulcers and pressure sores; burn wound infection, skin grafting graft area; old hematoma or effusion; wound infection after surgery [ 13]; colorectal cancer radical mastectomy and prophylactic postoperative wound drainage; intra-abdominal surgery (hepatobiliary pancreatic, upper gastrointestinal trauma or surgery) after prophylactic drainage; liver abscess, nsd spleen and peritoneal nsd cavity or peritoneal abscess After infection or abscess drainage; severe acute pancreatitis; pancreas, duodenum and upper gastrointestinal nsd leak trauma therapy [5].
1.4 1 pair required study material VSD material: foam requirements for medical non-toxic, non-irritating, non-antigenic, soft and has sufficient strength, corrosion resistance, good plasticity nsd and permeability. Currently in clinical use as a component of polyvinyl alcohol-type synthetic foam dressing (PVA foam), flexible, anti Zhang Liqiang, pores having a diameter of 0.2-1mm, excellent plasticity and water permeability, has good biocompatibility. Multi-lateral drainage holes No. 14-18 requires rigid silicon plastic drainage pipe, long 50cm, 14cm range within the first end with dense side holes, nsd in order to ensure high suction nsd lumen does not collapse, attract unobstructed. Paste the film required permeability of the skin similar to water vapor permeability, paste face a hypoallergenic waterproof adhesives, colorless and transparent, has good biocompatibility and barrier isolation. There is a special source nsd of negative nsd pressure suction drainage bottle nsd , when the bottle has been pumped nsd into the factory 80kPa (600mmHg) than negative, compact and easy to carry, can maintain 60-80kPa. electric suction allows the use of negative pressure reaches 80kPa, The disadvantage is that the patient can not move from the bed to attract long-term nsd continuous operation is unbearable, noisy suction . Center: The patient is a negative pressure source available, because of the need ambulatory treatment, outpatient NA.
1.4.3 Some studies propose nsd the following considerations [5]: end hole and side holes medical foam drainage tube should be completely wrapped to prevent clogging of the drainage tube; foam on both sides of each of the drainage canal width should not exceed 2-3cm, medical foam surface to ensure there is enough negative . foam filling to ensure full contact with the medical needs of the drainage of the wound, leaving no gaps; careful to avoid direct contact with the foam or across large blood vessels and nerves; body cavity leads should nsd take the shortest route, avoid the range at the time of drainage area around the drain or fill a closed nsd set omentum . paste film covering nsd at least to include nsd a margin of healthy skin closure . of 2-3cm of hand and foot can be " dumplings "method, that is around the hand, foot and paste the permeability of the film to each other, so that the fingers or toes like dumplings, films such as dumpling skin, achieve the purpose nsd of . once closed VSD can maintain an effective drainage of 3-10 days, with report that five days once a suitable nsd replacement nsd [5]. But there is more necrotic tissue replacement interval should be shortened to stop suction drainage indications . daily 20ml. If drainage is less than outpatient treatment nsd every 7 -9 referral to replace the drain, patients and their families are required to explain the observed drainage systems and management practices to maintain effective negative pressure is most important.
2.1.1 enhance nsd the drainage effect, reducing the bacterial colonization of the wound, provides a moist wound bed, which will help prevent infection: difficult to heal chronic wounds is mainly due to the lack of the wound inflammatory response, the lack of endogenous release of growth factor . Vacuum sealing techniques may enhance the inflammatory response wound rapidly, and this may help to reduce inflammation wound bacteria, thereby reducing secondary necrosis. In addition, the wound was closed transparent dressing can also prevent foreign bacteria from entering. While drainage patency can also be local wound necrotic tissue, secretions, bacteria, etc. sucked out, reducing the bacterial nsd growth medium. There are reports of negative pressure wound therapy group was significantly lower than the number of bacteria in the wound dressing conventional control group [1]. However, some experiments have shown negative pressure wound therapy group compared with the conventional dressing group and no significant reduction in the number of bacterial colonization [6].
2.1.2 relieve swelling around the wound, promote blood circulation. Edema due to fluid accumulation around the wound, reducing the capillary blood supply at the wound bed is not conducive to wound healing also increases the chance of infection. By using negative pressure can make even the smallest arteries, nsd increased mitosis, the formation of new vascular bed. While negative excess liquid can be removed initiative to help reduce swelling, which will help blood circulation. Measuring porcine groin wound lap during the treatment of vascular blood flow [6] found that the negative pressure nsd affects the blood flow at the edges of the wound, reducing ischemic tissue reaction. Tangsu Yang [10] detected using immunohistochemistry treatment PCNA expression and labeling index agnors particles nsd before and after the change and chronic wounds, were found to have increased. Description vacuum technology can enhance the chronic wound epidermal basal cells, skin cells in the hair follicle, sebaceous gland cells, fibroblasts, endothelial cell proliferative activity, and promote wound mitotic proliferation. It has been reported this method can minimize the number nsd of dressing changes [5,11,12], and therefore extend dressing change intervals are reduced due to the replacement of the dressing and fresh granulation tissue damage, accelerate the growth nsd of granulation.
2.3 Clinical Research: 1997 Argenta et al [21] first proposed as a new method for VAC therapy since chronic wounds, VAC has been significant progress in clinical applications, the performance of the VAC treatment methods and results of a new discovery nsd and understanding [20], developed VAC therapy practice guidelines [22, 23], and a cost analysis [24], and found that not only promotes healing and VAC therapy does not increase the cost [25], both for the treatment of hospitalized patients can also be therapeutic in the community and the family [26]. For the treatment of stress research suggests that, -125mmHg negative pressure wound blood flow allows 4 times
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