目的

比较硅橡胶封闭式负压引流系统与传统聚氨酯负压封闭引流系统治疗猪急性皮肤损伤的疗效。

方法

选择5 只实验用巴马小型猪，建立猪急性皮肤损伤模型。 在猪背部制造4个急性皮肤损伤创面，创面1、创面3 为长7 cm 深达肌层的长切口并缝合（缝合伤创面），创面2、创面4 为4 cm×4 cm 全层皮肤缺损创面（切割伤创面）。 同一实验动物创面1、创面2 使用硅橡胶封闭式负压引流系统治疗（实验组），创面3、创面4 使用聚氨酯负压封闭引流系统治疗（对照组）。 每5 天更换1 次敷料。 于治疗第10 天观察创面愈合情况，测量创面面积和创面体积，取创面肉芽组织行HE 染色、Masson 染色及CD31 免疫组化染色，比较2 组创面愈合率、创面与敷料黏连和出血情况，以及血管新生和胶原形成情况。

结果

缝合伤创面在治疗第5 天表皮已愈合，治疗第10 天HE 染色及Masson染色提示实验组创面两侧胶原纤维连接较对照组更明显。 切割伤创面治疗第10 天，2 组均可见创面缩小，2 组创面面积缩小率差异无统计学意义（41.13%±12.15%比34.14%±8.24%，t=-1.225，P=0.288），但实验组创面体积缩小更明显（72.47%±8.25% 比51.12%±9.39%，t=5.061，P=0.007）；CD31免疫组化染色及Masson 染色提示2 组创面均可见毛细血管增生及胶原形成，实验组CD31 平均光密度值（1.00±0.05 比0.57±0.04，t=-19.806，P＜0.001）及Masson 染色胶原容积分数（40.53%±10.71% 比24.94%±7.68%，t=-3.154，P=0.034）均高于对照组。 切割伤创面治疗第5 天，更换敷料时2 组均无创面与敷料黏连情况；治疗第10 天，揭除敷料时实验组未发生创面与敷料黏连情况，对照组创面与敷料发生明显黏连，且伴有创面出血（P＜0.05）。

结论

硅橡胶封闭式负压引流系统应用于猪急性全层皮肤缺损，可加快创面血管化及胶原形成，促进创面愈合，且减少更换敷料时创面与敷料黏连。

Objective

To compare the effect of silicone rubber vacuum sealing drainage system and traditional polyurethane vacuum sealing drainage system in treating acute skin defect in pigs.

Methods

Five Bama miniature pigs were selected to establish an acute skin injury model in pigs.Four wounds were constructed on the backs of the experimental Bama miniature pigs.The No.1 and No.3 wounds were sutured injury with a length of 7 cm and the deep from epidermis to the muscle layer （sutured wounds）， while the NO.2 and NO.4 wounds were cutting injury with 4 cm×4 cm full-thickness skin defect （incised wounds）.The NO.1 and NO.2 wounds were treated with silicone rubber vacuum sealing drainage system （experimental group）， while the NO.3 and NO.4 wounds were treated with polyurethane vacuum sealing drainage system（control group）.The dressings were changed every 5 days.On day 10 of the treatment， wound healing was assessed by measuring wound area and volume， the wounds were measured to compare the wound healing rate， adhesion and bleeding between the wound and dressing， and the angiogenesis and collagen formation were observed by hematoxylin-eosin staining， Masson staining， and CD31 immunohistochemical staining.

Results

The epidermis of suture injury wounds had healed on day 5 of the treatment both in experimental group and control group， but the results of hematoxylin-eosin staining and Masson staining showed that more collagen fiber connections between the two sides of the wounds was observed in experimental group.On day 10 of the treatment， the wound areas of cutting injury in both groups decreased， there was no significant difference between the two groups （41.13%±12.15% vs 34.14%±8.24%， t=-1.225， P=0.288）， while the wound volume reduction rate in experimental group was significantly higher than that in control group（72.47%±8.25% vs 51.12%±9.39%， t=5.061， P=0.007）.Capillary hyperplasia and collagen formation were both observed by CD31 immunohistochemical staining and Masson staining in the two groups， while the average optical density value of CD31 （1.00±0.05 vs 0.57±0.04， t=-19.806， P＜0.001） and collagen volume fraction of Masson staining （40.53%±10.71% vs 24.94%±7.68%， t=-3.154， P= 0.034） in experimental group were higher than that in control group.For suture injury，when changing the dressings on day 5， there was no adhesions in either group.When changing the dressings on day 10， there was no adhesion and bleeding in experimental group， while there were obvious adhesion and bleeding in control group（P＜0.05）.

Conclusion

The silicone rubber vacuum sealing drainage system used in acute fullthickness skin defect in pigs can accelerate the vascularization and collagen formation，promote wound healing， and reduce dressing adhesion during dressing changes.