The aims of this study were to observe the effects of vacuum sealing drainage ( VSD ) with three different negative pressures on the wound healing rate, macrophage count and the expression of hyaluronic acid ( HA ) as well as its receptor CD44 in seawater‐immersed blast‐injury wounds ( SIBIW ) and to determine the optimal negative pressure value. In a minipig SIBIW model, different suction pressures and routine dressing were applied. Histological and immunohistochemical comparisons as well as molecular biology methods were performed to compare the wound healing conditions, macrophage count and the levels of HA and CD44 . The wound healing rate of the VSD group was significantly higher than that of the control group, with the −120 mmHg group exhibiting the best effects. The macrophage count of the VSD group was higher than that of the control group. The HA level fluctuation was higher in the VSD group, with the −120 mmHg and the −180 mmHg groups showing the most significant fluctuation ( P < 0·05). CD44 was expressed in the full‐thickness wound‐limbic tissues and was higher in the treatment group than that in the control group, with the −120 mmHg group having the most obvious expression. VSD significantly improved the healing ability and increased the macrophage count and the HA content. It also promoted CD44 expression. −120 mmHg is the optimal negative pressure value.

The aim of this study was to dynamically observe and compare the effects of vacuum-assisted closure (VAC) technology on the healing of seawater-immersed blast-injury wounds (SIBIW) of pig skin soft tissues, and to summarize the mechanisms of VAC technology in promoting such SIBIW healing, with the goal of providing new experimental evidence for the rescue of such wounds. The bilateral scapular regions and hips of 5 small pigs underwent SIBIW with detonators. After the debridement, the pigs were randomly divided into control and experiment groups (VAC-120 mmHg group, VAC-180 mmHg group, VAC-240 mmHg group), with 5 wounds in each group. The control group's dressings were changed daily, and the experiment group's dressings were changed every other day. All wounds were treated for 9 days, and were observed until they had all healed (i.e., on the 58th day). We then compared and observed the macroscopic and microscopic changes in the wounds of each group. Compared with the control group, the experimental groups showed more active proliferation of peri-wound cells, and faster crawling of the epithelium. In the early stage, the expression of type I collagen was low, while that of type III collagen was higher, the bacterial index decreased rapidly, the bacterial transition was faster, and the wound healed faster. In treating SIBIW, VAC technology had obvious advantages over conventional therapy.

Objective To dynamically observe the effect of tumor necrosis factor alpha and bacteriological index at different negative pressures of Vacuum sealing drainage(VSD)on seawater-immersed blast-injury wounds so as to grope the optimal therapeutic negative pressure range. Methods The seawater- immersed blast- injury wounds were established on 5 experimental miniature swine at two sides of shoulders and hips.Each swine has 4 wounds and divided into 4 groups randomly:control group,VSD-120mmHg group,VSD-180mmHg group and VSD-240 mmHg group.All the wounds were removal of necrotic tissue and foreign bodies before treatment.The experimental groups were treated with VSD,and the control group was treated by regular method.The treatment on each wound continued for 9 days,and the observation continued until the 58th day.Tumor necrosis factor alpha expression and bacteriological index of wounds granulation tissue were respectively observed at 0,1,3,5,7,9 day and comparison were made among them. Results ①The bacteriological index of the experimental groups were decreased after treatment,but the control group ' s was increased in the first 3 days of treatment.The bacteriological index of the experimental groups was significantly lower than that of the control group after 3 days'treatment(P<0.01).②The bacterial composition took an obvious tendency of transition from seawater bacterium to skin fungus and from G-bacterium to G+bacterium.Compared with the experimental groups,the control group was slower in the rate of transition. ③In all groups,the TNF-α expression on wounds granulation tissue increased after trauma.Compared with the control group,the rate of increase and decrease were faster,and the summit peek value came earlier and higher significantly(P<0.01).The comparison among the adjacent pressure groups showed no statistical significance(P>0.05). Conclusions Compared with conventional therapy,VSD shows clear benefits during the treatment of seawater-immersed blast-injury wounds.The wounds inflammation was reduced by decreasing bacteriological index,changing bacterial composition,adjusting TNF-αexpression and so on in experimental groups,and-120mmHg pressure may be relatively ideal pressure.

目的 建立猪皮肤软组织海水浸泡爆炸伤创面动物模型.方法 选取8头(3头在预实验中死亡,5头进入实验)小型猪作为实验动物,在每头猪的双侧肩胛部、臀部制造4个损伤程度相当的海水浸泡爆炸伤创面,创面累及全层皮肤至脂肪层,肌肉、骨骼无明显损伤.结果 当雷管距皮肤0 cm时,创面较大,出血较多,伴邻近肢体骨折和局部肌肉缺损,于海水浸泡后6h死于全身多脏器损伤合并失血性休克;当雷管距皮肤1.0 cm时,肩胛部创面在范围、深度上均符合要求,但合并肺损伤,该猪于海水浸泡后32 h死于大面积肺梗死;当雷管距皮肤1.5 cm时,肩胛部和臀部的创面在范围、深度上均符合要求,创面可重复性好,但该猪于海水浸泡后10 h死于持续性低体温.立即改变海水浸泡方式,将炸后实验小型猪放置海水中改为海水持续浸泡爆炸创面1h,模型可重复性好,动物存活好.结论 雷管距猪皮肤为1.5 cm时,爆炸创面经海水浸泡1h,创面可重复性好,动物存活好,适合实验研究.

目的 通过动态对比观察封闭负压引流(vacuum sealing drainage,VSD)技术对猪皮肤软组织海水浸泡爆炸伤创面愈合及病理学变化的影响,初步探索治疗的最适压力范围.方法 用雷管在5头实验小型猪的双侧肩胛部、臀部制造4个损伤程度相当的海水浸泡爆炸创面,清创后随机分为对照组和实验组(VSD-120 mmHg负压组、VSD-180 mmHg负压组、VSD-240 mmHg负压组).每组5个创面,对照组每天常规换药,实验组隔1天换1次VSD敷料,共治疗9d,并动态观察至所有创面愈合(即治疗后58 d).分别于治疗前和治疗后9、30、58 d,取各组创缘组织行HE染色,并对比观察.结果 实验组与对照组相比,创周细胞增殖活跃,上皮爬行较快,肉芽增生迅速;以VSD-120 mmHg负压组最为明显,其次是VSD-180 mmHg负压组.结论 在治疗海水浸泡爆炸创面时,VSD技术较常规换药法具有明显的优势,-120 mmHg是比较理想的压力.