摘要
目的探讨阶梯状修剪原位回植结合持续负压封闭引流技术(VSD)治疗四肢皮肤逆行撕脱伤的临床效果。方法 2014年2月—2015年3月,由蚌埠医学院第一附属医院骨科同一组医师应用阶梯状修剪原位回植结合持续负压封闭引流技术治疗四肢皮肤逆行撕脱伤患者15例,男性9例,女性6例;年龄19~52岁,平均32.5岁。所有患者无周围血管疾病,所有撕脱皮肤均为逆行撕脱,无明显挫伤或仅有轻度挫伤,撕脱皮肤均较完整,有较好的软组织床或虽伴有肌肉断裂但经修复后软组织床良好,所对应的皮下组织无大面积的骨和肌腱外露,皮瓣撕脱面积为:(4 cm×5 cm)^(15 cm×18 cm)。术后给予抗感染、抗凝、抗痉挛治疗,调整负压,观察负压封闭引流敷料的颜色、管型、气味,保持负压封闭引流敷料持续负压吸引通畅、有效,术后1周打开负压封闭引流敷料,记录皮瓣的颜色、质地、弹性、感觉情况,评估皮瓣成活情况。结果 15例皮瓣全部成活,术后随访3~20个月,2例失访。3例皮瓣远端局部发黑经换药后愈合。成活皮瓣近端及中部色泽、质地、弹性、感觉等与正常皮肤无异,远端皮瓣色泽暗,质薄,弹性差,皮肤感觉迟钝或无感觉。结论阶梯状修剪原位回植结合持续负压封闭引流技术手术操作简便易行,学习曲线短,临床疗效满意,是治疗四肢皮肤逆行撕脱伤的有效方法之一。
Objective To discuss the clinical efficacy of in situ skin grafting in a zigzag pattern combined with vacuum sealing drainage（ VSD） in the treatment of retrograde skin avulsion injury of limbs. Methods Total 15 patients with retrograde skin avulsion injury of limbs,9 males,6 females,average age 32. 5 years（ 19 to 52 years）,underwent in situ skin grafting in a zigzag pattern combined with VSD in our hospital between February,2014 and March,2015. There was no peripheral vascular disease among these patients,all skin avulsion was retrograde skin avulsion and complete,area of the avulsion skin was from（ 4 cm × 5 cm） to（ 15 cm × 18 cm）,without or only with mild contusion,the subcutaneous soft tissue bed was good,or could be restored though accompanied by muscle rupture,without large area exposed bone and tendon. The antibiotics,anticoagulation and antispasmodic therapy were applied after the operation. The negative pressure was adjusted to keep unobstructed VSD dressing continuous drainage. The color,tube type and smell of VSD were observed after the operation. The VSD dressing was removed one week after the operation to assess the survival situation of the skin by recording the color,texture,elasticity and sensation of the flap. Results All 15 flaps survived uneventfully. Two cases were lost in the follow up of 3 months to 20 months. Three cases with distal partial blackened flap were healed by dressing. Compared with normal skin,there was no difference in the color,texture,elasticity and sensation of the proximal and central part of survival flap. However,the distal part of survival flap was dark,thin,poor elasticity,dysaesthesia or anesthesia. Conclusion The in situ skin grafting in a zigzag pattern combined with VSD show the advantages of simple and easy technique,short learning curve and satisfactory clinical efficacy,it is one of effective procedures in management of retrograde skin avulsion of limbs.
出处
《中华全科医学》
2017年第4期602-604,共3页
Chinese Journal of General Practice
关键词
负压封闭引流术
逆行
撕脱伤
四肢
Vacuum sealing drainage
Retrograde skin avulsion injury
Limbs
