[Mode of debridement, negative-pressure therapy combined with tissue transplantation for treatment of complicated and refractory wounds].

Objective: To observe therapeutic effect of negative-pressure treatment combined with tissue transplantation on complicated and refractory wounds after debridement.

Methods: After debridement, 20 patients with 20 complicated and refractory wounds hospitalized in our burn wards from May 2008 to June 2010 were randomly divided into treatment group (T, treated with negative-pressure from -19 kPa to -8 kPa, n = 10) and control group (C, covered with petrolatum gauze overlaid with saline gauze and dry gauze, n = 10) according to alternating method. On post treatment day (PTD) 4, 7, and 14, granulation tissues of wound surface in size of 4 mm × 3 mm × 2 mm were harvested for histopathological observation (including capillary growth, inflammatory cells, and collagen arrangement) with HE staining, and the numbers of vascular endothelial cells (VEC, with addition of rabbit anti-human coagulation factor VIII related antigen polyclonal antibody) and proliferation period cells (with addition of mouse anti-human Ki-67 monoclonal antibody) were counted by immunohistochemical staining. Data were processed with t test. Another 59 patients harboring 62 complicated and refractory wounds admitted to our burn ward at the same period were treated with the same mode of debridement, negative-pressure therapy, followed by timely skin or skin flap grafting.

Results: (1) Granulation tissue in T group grew more rapidly than that in C group. More capillaries and less inflammatory cells were observed in T group on PTD 7 as compared with those in C group. Collagen in T group on PTD 14 was more regular in arrangement than that in C group. The number of VEC per 400 times visual field in T group on PTD 4, 7, and 14 was respectively higher than that in C group (108.7 ± 11.2 vs. 31.0 ± 3.6, 138.0 ± 14.7 vs. 34.6 ± 4.5, 68.7 ± 6.9 vs. 55.1 ± 6.5, with t values from 4.62 to 30.28, P values all equal to 0.01). The number of proliferation period cell per 400 times visual field in T group on PTD 4 and 7 was respectively higher than that in C group (88.9 ± 5.9 vs. 16.6 ± 3.3, 128.1 ± 13.0 vs. 110.1 ± 8.9, with t value respectively 19.89, 3.33, P values all below 0.05). The number of proliferation period cell per 400 times visual field in T group on PTD 14 was obviously lower than that in C group (26.7 ± 5.1 vs. 59.7 ± 4.5, t = -12.43, P = 0.01). (2) After being treated with above therapeutic mode, necrotic tissues were removed completely and granulation tissue grew rapidly in 62 complicated and refractory wounds with high survival rate of skin grafts or skin flaps with good repair effect.

Conclusions: Negative-pressure therapy can accelerate VEC formation and stimulate cell proliferation after debridement. Debridement, negative-pressure therapy, and timely skins/skin flaps grafting can effectively increase healing rate of complicated and refractory wounds.