摘要
目的探讨对接触海水后小腿下段及足踝部有肌腱暴露创面的处理。方法对16例有海水接触史的小腿下段及足踝部有肌腱暴露的创面入院后立即用大量生理盐水反复冲洗创面,彻底清创,尽量保留腱周及肌腱"间生态"组织。选用敏感抗生素液湿敷1～2d后视肉芽情况行修复手术。同时应用敏感抗生素抗感染。本组均采用远端蒂腓肠神经营养血管皮瓣进行修复创面,并外踝尖以下2cm处的半圆周上经皮交叉缝扎小隐静脉干及其部分属支以减轻静脉血倒灌。术后进行充分的引流、确实的患肢抬高和适当的功能锻炼。结果除1例皮瓣因设计略偏小,缝合后张力较大,出现远端边缘坏死,经补充移植皮片后愈合。其余皮瓣均完全成活,且无明显瘀紫、肿胀。肌腱修复后经康复治疗,功能基本恢复正常。结论及时、合理的清创以尽早、尽量去除海水的不良作用,尽早用血供丰富且对机体损伤小的皮瓣覆盖创面,术后充分的引流、确实的抬高患肢和适当的功能锻炼,是成功修复接触海水后小腿下段及足踝部有肌腱暴露创面的关键。
Objective To explore the methods of repairing the wounds contacting seawater with exposured tendons at the inferior leg and malleolus.Methods Sixteen cases with the wounds contacting seawater with exposured tendons at the inferior leg and malleolus were studied.The wounds were repeatedly flushed by enormous normal saline,and were thoroughly debrided.The tendons tissues and the around between-alive-and-dead tissues were reserved as possible.The debrided wounds were wet compressed with sensitive antibiotic solution.If the granulation was good after 1~2 days,the distally based sural neurocutaneous flaps were used to repair the wounds.The lesser saphenous vein trunk and most of its branches were blocked by percutaneous suturing at the lower half circle,whose centre was at 2cm distal to the tip of the external ankle.Ample draining,lifting the ill leg,and appropriate physical exercise were used postoperation.Results There was only 1 flap with partial edge necrosis,because the flap was designed smaller than needed and high tension occurred after suture.Other flaps survived,and had no obvious extravasated blood.The functions of the repaired tendons recovered after appropriate physical exercise.Conclusion Timely debridement to remove the ill effect of the seawater,early repairing with flaps having plentiful blood-supply and light injury to the body,ample draining,lifting the ill leg,and appropriate physical exercise after operation were the keys to repair the wounds contacting seawater with exposured tendons at the inferior leg and malleolus.
出处
《华南国防医学杂志》
CAS
2010年第1期17-20,共4页
Military Medical Journal of South China
关键词
海水浸泡
创面
肌腱
皮瓣
腓肠神经
小隐静脉
Seawater immersion
Wound
Tendons
Flap
Sural nerve
The lesser saphenous vein
