上肢大面积软组织脱套伤的治疗
|
摘要
目的探讨上臂及前臂软组织脱套伤利用全厚皮片及减张后联合应用负压封闭引流技术(Vacuum Sealing Drainage, VSD)修复的临床效果。方法 2012年8月-2017年6月,采用修剪脱套皮缘成全厚皮片,并在脱套皮肤上作纵行减张,创面彻底止血,VSD修复创面22例,上肢皮肤脱套面积16 cm×10 cm~28 cm×20 cm。结果临床应用22例,15例全部成活,7例皮缘小部分坏死,经再次植皮创面全部成活。随访6个月~5年,皮肤成活质地好,色泽正常,上肢外形与功能改善满意,痛、深触觉正常存在。结论利用脱套皮肤减张,创面彻底止血,辅助VSD创面吸收,能减少皮下积血,增加脱套皮肤与创面肌肉的接触面积,提高皮肤成活率,并与健康皮肤质地相似,修复效果好。
Objective To investigate the clinical effect of full thickness skin-graft reduction and VSD repair on the upper arm and forearm soft tissue avulsion. Methods The clinical application of pruning and removing the skin margin to complete thickness was performed on the degloving skin, with longitudinal tension reduction and complete wound hemostasis. 22 cases were covered with VSD, and the skin area of the upper limb was 16 cm×10 cm~28 cm×20 cm. Results The clinical application was in 22 cases, all skin survived in 15 cases, small part of the skin edge had necrosis in 7 cases, after replanting the skin wounds all survived. The follow-up time ranged from 6 months to 5 years, the skin survival quality was good,color and texture was normal, the shape and function of the upper limb were satisfactory, pain and deep touch were normal. Conclusion The use of skin degloving reduction, complete wound hemostasis,wound absorption supplemented by VSD, can reduce subcutaneous hemorrage, increase the contact area between the skin and the wound muscle and increase the skin survival rate, so as to achieve similar texture and good repair effect.
Objective To investigate the clinical effect of full thickness skin-graft reduction and VSD repair on the upper arm and forearm soft tissue avulsion. Methods The clinical application of pruning and removing the skin margin to complete thickness was performed on the degloving skin, with longitudinal tension reduction and complete wound hemostasis. 22 cases were covered with VSD, and the skin area of the upper limb was 16 cm×10 cm~28 cm×20 cm. Results The clinical application was in 22 cases, all skin survived in 15 cases, small part of the skin edge had necrosis in 7 cases, after replanting the skin wounds all survived. The follow-up time ranged from 6 months to 5 years, the skin survival quality was good,color and texture was normal, the shape and function of the upper limb were satisfactory, pain and deep touch were normal. Conclusion The use of skin degloving reduction, complete wound hemostasis,wound absorption supplemented by VSD, can reduce subcutaneous hemorrage, increase the contact area between the skin and the wound muscle and increase the skin survival rate, so as to achieve similar texture and good repair effect.
引文
[1]潘达德,顾玉东,侍德,等.中华医学会外科学会上肢部分功能评定试用标准[J].中华手外科杂志,2000,16(3):130-135.
[2]洪新,王文跃,朱海涛,等.皮瓣原位回植联合负压封闭引流治疗四肢不完全皮肤撕脱伤[J].临床骨科杂志,2013,16(1):31-32.
[3]徐建华,阚世廉,张建兵.原位缝合结合负压封闭式引流治疗手及前臂皮肤逆行撕脱伤[J].实用手外科杂志,2013,27(3):332-334.
[4]崔邦胜,郭锋,陈棉智.皮肤原位回植联合负压封闭引流治疗手部皮肤撕脱伤[J].实用手外科杂志,2013,27(3):371-373.
[5]李海堂.封闭式负压引流术治疗上肢软组织缺损的临床观察与护理[J].实用手外科杂志,2016,30(2):238-340.
[2]洪新,王文跃,朱海涛,等.皮瓣原位回植联合负压封闭引流治疗四肢不完全皮肤撕脱伤[J].临床骨科杂志,2013,16(1):31-32.
[3]徐建华,阚世廉,张建兵.原位缝合结合负压封闭式引流治疗手及前臂皮肤逆行撕脱伤[J].实用手外科杂志,2013,27(3):332-334.
[4]崔邦胜,郭锋,陈棉智.皮肤原位回植联合负压封闭引流治疗手部皮肤撕脱伤[J].实用手外科杂志,2013,27(3):371-373.
[5]李海堂.封闭式负压引流术治疗上肢软组织缺损的临床观察与护理[J].实用手外科杂志,2016,30(2):238-340.