Objective: To explore the role of hyperbaric oxygen therapy in promoting wound healing in donor site.
Results: 15 cases of donor wounds healed quickly after hyperbaric oxygen treatment, with an average healing time of 10 day. The donor site wound healed ruddy, the inner dressing fell off early and there was no wound infection.
15 cases were not treated with hyperbaric oxygen, and the wound healed slowly. The average healing time was 17 days, and the internal dressing had not completely fallen off at the time of discharge, of which 1 case was infected.
Based on the time when the inner dressing in donor site was completely removed, SPSS 10.0 statistical software was used for analysis, P
Conclusion: Hyperbaric oxygen therapy after skin excision can obviously promote the wound healing of donor site.
[Keywords:] Hyperbaric oxygen; Donor site wound; Promotion; alliance
Skin grafting is a common treatment method in plastic surgery. It is common that the wound in the donor site is difficult to heal, or it takes a long time to heal, and even a large area of skin graft patients are infected, which brings great pain to patients.
It is found that hyperbaric oxygen therapy can increase tissue oxygen concentration and promote wound healing.
15 cases of back skin were treated with hyperbaric oxygen, and compared with 15 cases of similar back wounds without hyperbaric oxygen treatment. The results showed that the wound healing in hyperbaric oxygen treatment group was satisfactory and the clinical effect was exact.
1 data and methods
1. 1: 30 patients' clinical data, all adult males, were normal before operation, and the hemoglobin concentration ranged from1.20 ~1.30g/L. Because of huge moles, scar contracture, hemangioma, etc., we chose the back as the donor area for free transplantation of medium-thick skin graft. 6cm~8cm？ 8cm, with an average age of 24 years.
There was no significant difference in age, preoperative hemoglobin, skin graft area and skin graft thickness between the two groups.
Among them, 15 cases were treated with hyperbaric oxygen for 6 consecutive times after operation, and 15 cases were not treated with hyperbaric oxygen after operation.
1.2 method
1.2. 1 Operation: Take the patient in prone position during the operation. After routine disinfection and towel laying, a certain area of medium-thick skin graft was taken from the back with a leather drum. After skin removal, the wound in the donor site was pressurized with1:0.2 million/200 thousand epinephrine saline to stop bleeding, then the wound was covered with vaseline gauze, covered with sterile cotton pad, and finally wrapped with chest band.
1.2.2 hyperbaric oxygen therapy: The patient started hyperbaric oxygen therapy from the second day after operation,/kloc-0 times a day, 6 times in a row. The pressure of the hyperbaric oxygen chamber is 2 atmospheres (ATA), 65438 000% pure oxygen is inhaled, the pressure is increased and decreased for 65438 05 minutes, and the pressure is stabilized for 45 minutes.
1.2.3 wound observation method: On the 7th day after operation, open the external dressing to observe whether there is wound exudation and infection, and then change the external dressing every day until the innermost dressing completely falls off and the wound heals. In the case of infection, the internal dressing at the infected site should be removed at the same time, and the wound should be disinfected and changed every day until the wound heals.
1.2.4 statistical method: The wound healing time (in days) was recorded based on the time when the dressing was completely removed in the donor area, and the wound healing time was compared between the two groups based on 10 day, using SPSS 10.0 statistical software, and the results were obtained by chi-square test (P
Two results
In hyperbaric oxygen therapy group, the average healing time of donor wounds was 10 day, and 2 cases exceeded 10 day. After 7 ~ 65,438+00 days, the inner dressing has fallen off, and the wound color is good after healing (Figure 65,438+0), and no wound infection occurs. The average healing time of donor site in non-hyperbaric oxygen treatment group was 17 days, and the healing time of patients in postoperative hyperbaric oxygen treatment group was significantly shortened 1 case. The healing time of patients in the non-hyperbaric oxygen treatment group was significantly longer than 10 day, and the internal dressing was still difficult to fall off completely when discharged from hospital, as shown in Figure 2 ~ 4.
3 discussion
Chronic wound nonunion is an important challenge to health. The local environment of the wound is very important for healing, and the existence of oxygen is an important factor for healing, which is directly related to the oxygen level of the tissue. Hypoxia environment is not conducive to healing, including affecting angiogenesis, fibroblast proliferation, collagen synthesis, epithelial growth and the bactericidal ability of white blood cells [1].
The oxygen storage capacity of human body is very poor, and the safe blood-breaking time of inhaling at normal pressure is only 3.5 min.
The use of hyperbaric oxygen improves the oxygen content in the whole body and local area. In recent years, with the wide application of hyperbaric oxygen therapy, it is not limited to respiratory medicine, but also achieved unique results in other departments, especially for wound healing, which plays an important role in healing [1-2].
3. 1 Hypoxic injury of wound surface in donor site after skin removal [3-7]: Oxygen is very important for intracellular aerobic metabolism (fibroblast proliferation, collagen synthesis, angiogenesis, collagen transport and epithelization of fibroblast membrane surface, etc.). ).
Tissue ischemia and hypoxia (oxygen level below 30mmHg) will damage normal metabolic activity and wound healing: ① The formation of blood vessels at the edge of wound is determined by the existence of oxygen concentration difference. The formation of oxygen concentration gradient between hypoxic wound and surrounding normal tissue can stimulate the formation of blood vessels. There is less oxygen in the center of the wound, but there is plenty of oxygen around it. The concentration difference drives macrophages to produce angiogenic factors until angiogenesis towards the center of the wound is completed. High concentration oxygen supply to the wound can make the wound edge reach the anoxic center. ② Hypoxia damages the body's anti-infection ability, and the content of bacteria in hypoxic tissues is high. High oxygen concentration can enhance the production of oxygen free radicals by white blood cells and kill bacteria.
3.2 Physiological function of hyperbaric oxygen and mechanism of promoting donor wound healing [8-9]: Intermittent inhalation of 100% pure oxygen in hyperbaric oxygen chamber above 1 ATA can increase the oxygen level of tissues by 10 times.
Under normal circumstances, 98% of oxygen is combined with hemoglobin, and only 2% is dissolved oxygen. According to Henry's law, the higher the atmospheric pressure, the higher the dissolved oxygen content, and the dissolved oxygen content can still exist at a high level for 2 ~ 4 hours after hyperbaric oxygen treatment.
Studies have shown that the oxygen content can be increased to 65,438+0,500 mmHg at 65,438+0 atm, and 2,000 mmHg at 2 ~ 3 atm, which is enough to supply all metabolic activities of tissues, even without hemoglobin.
In typical diabetic foot patients, the normal partial pressure difference is 20 ~ 30 mmHg, while the normal partial pressure difference is 40 ~ 60 mmHg. After hyperbaric oxygen therapy, the partial pressure difference is 200 ~ 40~60mmHg, which may be higher.
The mechanism of HBO on donor site wound healing is [10- 1 1]: increasing tissue oxygen partial pressure and increasing blood oxygen content; Increase tissue blood flow, improve microcirculation and promote the establishment of collateral circulation; Conducive to the recovery of diseased blood vessels; Can accelerate the healing of ulcer surface, resist infection, accelerate capillary proliferation, and directly act on vascular smooth muscle? Receptors, relieve vasospasm and promote angiogenesis by producing factors that induce angiogenesis.
3.3 Prospect of hyperbaric oxygen therapy for donor wounds: The above study found that hyperbaric oxygen can obviously shorten the healing time of donor wounds, prevent infection of donor wounds and improve the quality of wound healing.
In view of the patients who need to get back their skin during operation, the author mobilized the patients to receive hyperbaric oxygen therapy after operation, and planned to analyze the large-scale clinical data, and regarded hyperbaric oxygen therapy as the routine treatment of donor wounds.
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