Vacuum sealing drainage (VSD) technique is a new technique and method for treating acute and chronic soft tissue injuries, which is a new drainage technique with unique design and significant improvement to traditional surgical drainage, and is a revolution in soft tissue treatment. It was created in the 1990s by Dr. Wim Fleischmann of the Ulm University Hospital for Trauma Surgery in Germany for the drainage of extremity wounds. Initially, it was used to treat soft tissue infected wounds on the trunk and extremities, and the application effect was soon confirmed and gradually extended to the clinical treatment of various post-trauma problem wounds, such as chronic long-lasting ulcer wounds, large soft tissue injury wounds, and special area wounds (head, hand, perineum). After nearly 10 years of clinical application, it has been proved that this technique has significantly improved the drainage effect and provided a new treatment pathway for some diseases that are difficult and ineffective to treat with traditional methods. In many foreign hospitals, VSD technique has been adopted as the standard treatment method for these traumatic wounds, and is applied to the treatment of acute soft tissue contusions, acute infected wounds, crush injuries, diabetic foot, burns and other difficult to heal wounds. Negative pressure closed drainage, which has been carried out in recent years in clinical practice and applied to the treatment of acute soft tissue injuries, crush injuries, acute infected wounds, diabetic foot, burns and other difficult-to-heal wounds, is a revolution in soft tissue treatment, and years of research have yielded significant clinical results. Negative pressure closed drainage helps to improve trauma microcirculation, promote benign regression of burn stasis zone, reduce tissue edema and lactic acid accumulation, inhibit bacterial population, drain necrotic liquefied tissues and exudate, effectively reduce various harmful metabolites into blood circulation, and also promote granulation tissue and trauma growth, which can shorten hospitalization time, reduce patient hospitalization cost, and improve salvage rate. The terms related to this method are: vacuum sealing drainage (VSD), vacuum sealing closure (VSC), superficial negative pressure (TNP), suction wound closure therapy ( The author believes that it is more appropriate to call it vacuum sealing closure (VSC), superficial negative pressure (TNP), suction wound closure therapy (SWCT), and negative pressure wound therapy (NPWT). Some hospitals in China have successfully applied this method and partially replaced various kinds of drainage for trauma and general surgery patients, but due to the limitation of each hospital, this technology and method have not been popularized. In this paper, we review the current situation of basic and clinical research on VSD application, expecting that VSD will gradually become one of the comprehensive treatment means for trauma defective trauma and/or trauma cavity in domestic hospitals. (1) Polyvinyl alcohol gelatin sponge foam (trade name “Vacuseal? Vickers Wound”): 0.2~1mm microporous, white, non-toxic, non-immune, corrosion-resistant, with strong adsorption and water permeability, soft, strong resistance to tension, (2) multi-lateral pore drainage tube: 0.8 cm in diameter, embedded in gelatin sponge foam material; (3) negative pressure drainage device: a central negative pressure suction device (negative pressure of 60-70 mmHg) or a special negative pressure suction bottle device (capable of generating a negative pressure of 60-80 mmHg); (4) bio-transparent permeable sealing Patch: larger area than Vacuseal, with good transparency, oxygen permeability and moisture permeability, waterproof and prevent bacterial invasion, and can observe the trauma surface. Before use, the wound or cavity is thoroughly cleared, Vacuseal is trimmed and filled in at a size slightly smaller than the wound or cavity, the normal skin around the wound edge is intermittently sutured with the edge of Vacuseal material, and finally a biological semi-permeable film is glued on top of the material to close it. The drainage tube was poked through the normal skin 2-3 cm away from the wound or the wound cavity and connected to a negative pressure drainage bottle for 24 hours without interruption, and after 5-7 days, it was decided whether to remove or replace it, or to carry out phase II treatment such as skin graft or flap transfer according to the condition of the wound. 2, mechanism of action Comprehensive literature reports [5] VSD mechanism of action mainly include: as an intermediary between trauma and drainage tube, drainage from point to point to achieve full trauma drainage, changing the traditional trauma and/or trauma cavity drainage; negative pressure suction combined with flushing to ensure unobstructed drainage and trauma in a relatively clean environment, remove necrotic tissue, reduce the amount of bacteria on the trauma (because bacteria are not easy to survive under negative pressure); facilitate The negative pressure attraction acts on the cell membrane, causing it to expand and distort, transducing information to the cell nucleus, and through signal transduction, causing the cells to secrete prehealing growth factors, including vascular proliferation factors. including vasoproliferative factors, thus stimulating the tissue to produce more new capillaries. 3. basic research on the application of VSD The mechanism of the use of VSD on injured wounds to promote the growth of granulation tissue and accelerate wound healing has been partially described at the cellular-molecular level in conjunction with the observation of a large number of clinical cases. debus et al [6] found that the expression of various growth factors was increased in the wound secretions, and that the coordination of these factors with each other was necessary for wound healing and for complete recovery of histomorphology, while in Phase II and delayed healing, the role of these factors is disordered. 4. Clinical application research VSD has revolutionized the treatment of acute and chronic wounds after trauma, and has been widely used in trauma surgery, general surgery, orthopedics and burns. Using VSD as a new treatment mode for difficult-to-heal soft tissue injury wounds, selecting those patients with large soft tissue defects and/or infections after severe trauma, the existence of soft tissue wounds or wounds cavities that cannot or should not be closed after conventional treatment and debridement, and applying VSD after emergency or non-emergency debridement, is beneficial to accelerate wound healing and promote the growth of injured tissues. It has the advantages of reducing or preventing trauma infection, accelerating trauma healing, reducing patient pain, reducing patient psychological burden, increasing patient compliance, shortening treatment time, and reducing the workload of doctors and nurses to improve work efficiency.Polykandriotis et al [4] innovatively applied VSD to nine patients with traumatic hand injuries and concluded that VSD could treat or prevent hand defect trauma infection and alleviate local pain. Yao Yuanzhang et al. reported that VSD was widely applied to 316 patients (341 traumas) with large soft tissue defects, avulsions and chronic infection of traumas after various types of trauma, covering all types of injuries such as traffic accidents, engineering accidents, fall injuries, knife and cut injuries, gunshot injuries and explosion injuries; the traumas were anatomically distributed on the head, trunk and extremities; there were 190 fresh traumas and 126 old and infected traumas. The traumas ranged from 6 cm × 10 cm to 20 cm × 90 cm in size; the average use of VSD was 9 days. Of the 341 wounds, 32 were healed directly by VSD, 210 were closed by skin graft, 24 were closed by free flap, 41 were closed by local transfer flap, and 34 were closed by second-stage suture. 286 of 316 patients were followed up for more than 3 months, with a follow-up rate of 90.5%. The quality of patient survival was excellent in 123 cases (43.00%), good in 105 cases (36.71%), moderate in 51 cases (17.83%), and poor in 7 cases (2.46%). In the past 4 years, 63 cases of severe open fractures of the extremities were treated with VSD plus external fixator. After debridement, the fractures were fixed with Orthofix unilateral external fixator, the trauma surface or trauma cavity was covered with Vacuseal material, connected with negative pressure closed suction, and the second stage suture, skin graft or flap transfer after 6-10 days. All trauma surfaces healed, with superficial infection in 3 cases (4.8%) and needle tract infection in 13 cases and 19 stitches (7.5%); fractures healed in 53 cases (84.1%) and delayed healing or non-healing in 10 cases (15.9%). The mean healing time was 6.5 months. It was concluded that the VSD method combined with external fixation frame fixation for the treatment of severe open fractures of the extremities, while rapidly and effectively stabilizing the fracture, can safely and effectively close the trauma, shorten the second-stage trauma repair time, promote fracture healing, and reduce complications; its method is simple and effective. 5. Indications, contraindications and precautions VSD is indicated for large soft tissue defect trauma and/or trauma cavity; after large hematoma or fluid removal; after incision and decompression for osteofascial compartment syndrome; open fracture with soft tissue defect and possible co-infection; acute and chronic osteomyelitis requiring open window drainage; diabetes mellitus, lower limb varicose veins causing chronic calf ulcers, patients with sacrococcygeal pressure sores; body surface abscess and infection After incision and drainage; post-surgical incision infection and fissure; liver abscess, spleen abscess and peritoneal cavity or retroperitoneal abscess or infection; abdominal drainage in acute necrotizing pancreatitis combined with infection; those who are at risk of rupture after digestive anastomosis; those who need to prevent extravasation and accumulation of blood, bile and pancreatic fluid after hepatobiliary and pancreatic trauma or surgery; those whose residual cavity is large and not easily eradicated after surgery and who have the possibility of fluid accumulation, etc. Contraindications to VSD: wounds with presence of cancer, significant wet gangrenous changes, wounds with dry scorch, untreated chronic osteomyelitis, wounds that are bleeding or oozing blood, direct use on exposed vascular nerves and organs. Precautions for the use of VSD: (1) Emphasis on early and rational application, early use in patients with obvious indications can be twice as effective, while in patients with small trauma, no obvious infection or no threat of serious infection, the pros and cons need to be weighed and should not be blindly abused; (2) VSD puts the trauma in a negative pressure, relatively isolated state, and anti-anaerobic treatment should not be ignored; (3) Prevent the occurrence of negative nitrogen balance. VSD daily aspirated exudate contains a large amount of protein, should pay attention to monitoring, calculation and timely supplementation of nutritional needs; (4) avoid collapse of the suction tube after continuous negative pressure suction, or loss of negative pressure due to closed air leakage, should promptly update the tube or re-closure, so as not to affect the therapeutic effect; regularly disinfect the skin and replace the bio-permeable film: (5) bio-permeable film has limited oxygen and moisture permeability, and Bacteria from hair follicles and sebaceous glands can gradually move to the skin surface, so they need to be replaced and disinfected regularly. It should be noted that VSD has limitations as an innovative measure for trauma treatment. If the patient’s own factors can be excluded, the treatment should be changed, but when the trauma deteriorates, the treatment should be changed even if it is less than 3 weeks. 6. Outlook VSD, as a new cutting-edge technological approach to trauma repair, has revolutionized the treatment of acute and chronic trauma. A special center for negative pressure trauma treatment has been established in the United States and has achieved remarkable results. After the introduction of this method in our department, we have also achieved good results in the treatment of difficult-to-heal soft tissue injury wounds. With the development of cell biology and molecular traumatology, the deepening of basic research and clinical application research of VSD, and the continuous improvement of technical methods and materials, its application fields will become more and more extensive, which not only provides doctors with a simple, economic, safe and effective treatment method for wound closure or repair, but also brings gospel to countless patients. Its application area will become more and more extensive.