负压封闭引流技术联合腓肠神经营养血管皮瓣治疗足踝部软组织缺损的效果观察
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摘要
目的探讨治疗足踝部软组织缺损采用负压封闭引流技术(VSD)联合腓肠神经营养血管皮瓣的临床效果。方法选取2015年3~6月我院收治的足踝部软组织缺损60例患者,将其随机分为对照组和研究组,每组各30例。对照组给予常规换药联合腓肠神经营养血管皮瓣的治疗方法,研究组给予VSD联合腓肠神经营养血管皮瓣的治疗方法。比较两组的换药次数、术前准备时间、抗生素使用时间及患者术后的住院时间。术后随访6个月,比较两组创面感染、皮瓣坏死的发生率及踝关节功能评分和疼痛VSA评分。结果研究组的换药次数少于对照组,术前准备时间及抗生素的使用时间均短于对照组(P<0.05);随访期间,研究组创面感染和皮瓣坏死发生率均远低于对照组(P<0.05);研究组踝关节功能评分和疼痛VSA评分均优于对照组,差异均有统计学意义(P<0.05)。结论VSD联合腓肠神经营养血管皮瓣治疗足踝部软组织缺损效果较理想,能显著缩短治疗时间,减小创面感染和皮瓣坏死的发生率,值得在临床上推广应用。
Objective To investigate the clinical effect of negative pressure closed drainage(VSD) combined with sural neurocutaneous vascular flap in the treatment of soft tissue defects of the ankle. Methods A total of 60 patients with soft tissue defect of the ankle from March to June 2015 in our hospital were selected and randomly divided into control group and study group, 30 cases in each group. The control group was treated with conventional dressing method combined with sural neurovascular flap, treatment group was given the negative pressure closed drainage treatment method combined with sural nerve nutrient vessel flaps. After the experiment, the times of change, the time of preparation, the time of use of antibiotics and the time of hospitalization were compared between the two groups. The postoperative patients were followed up for 6 months, and the incidence of wound infection, skin flap necrosis, ankle joint function score and pain VSA score in the two groups were compared. Results The number of dressing operation patients in the study group was lesser than that in the control group, preparation time and time of antibiotics were shorter than that in the control group(P<0.05). Probability study group of patients with wound infection and skin flap necrosis occurred during follow-up were much lower than that of the control group(P<0.05). Ankle joint pain score and VSA score of patients in study group were better than that in the control group, the differences were statistically significant(P<0.05).Conclusion Vacuum sealing drainage combined with sural neurocutaneous flap in the treatment of foot and ankle soft tissue defects is effective, which can significantly shorten the treatment time, reduce the incidence of wound infection and skin flap necrosis, and is worthy of clinical application.
Objective To investigate the clinical effect of negative pressure closed drainage(VSD) combined with sural neurocutaneous vascular flap in the treatment of soft tissue defects of the ankle. Methods A total of 60 patients with soft tissue defect of the ankle from March to June 2015 in our hospital were selected and randomly divided into control group and study group, 30 cases in each group. The control group was treated with conventional dressing method combined with sural neurovascular flap, treatment group was given the negative pressure closed drainage treatment method combined with sural nerve nutrient vessel flaps. After the experiment, the times of change, the time of preparation, the time of use of antibiotics and the time of hospitalization were compared between the two groups. The postoperative patients were followed up for 6 months, and the incidence of wound infection, skin flap necrosis, ankle joint function score and pain VSA score in the two groups were compared. Results The number of dressing operation patients in the study group was lesser than that in the control group, preparation time and time of antibiotics were shorter than that in the control group(P<0.05). Probability study group of patients with wound infection and skin flap necrosis occurred during follow-up were much lower than that of the control group(P<0.05). Ankle joint pain score and VSA score of patients in study group were better than that in the control group, the differences were statistically significant(P<0.05).Conclusion Vacuum sealing drainage combined with sural neurocutaneous flap in the treatment of foot and ankle soft tissue defects is effective, which can significantly shorten the treatment time, reduce the incidence of wound infection and skin flap necrosis, and is worthy of clinical application.
引文
[1]王慎东,鲁彧,周建芹,等.负压封闭引流联合腓肠神经营养血管皮瓣治疗足踝部软组织缺损[J].中国临床保健杂志,2015,13(4):422-424.
[2]刘伟涛.腓肠神经营养血管皮瓣修复小腿及足踝部皮肤软组织缺损[J].临床和实验医学杂志,2017,16(19):1962-1965.
[3]周萍,桂程丽,龚晓丽.VSD引流配合远端蒂腓肠神经营养血管皮瓣转移修复足踝部软组织缺损的临床护理[J].河北医药,2015,37(3):467-469.
[4]徐鹏,刘延辉,俞伟忠,等.负压封闭引流联合小腿远端蒂岛状皮瓣治疗足踝部软组织缺损[J].实用手外科杂志,2015,29(3):272-273.
[5]朱晓浩,陈卓,王雪丽,等.腓肠神经营养血管逆行岛状皮瓣治疗严重小腿远端及足踝部损伤[J].局解手术学杂志,2017,26(8):620-623.
[6]曲新强,刁雷鹏,刘兴龙,等.负压封闭引流术结合腓肠神经营养皮瓣治疗外伤性跟腱外露[J].实用医药杂志,2015,14(5):441-442.
[7]Zheng H,Liu J,Dai X,et al.The Distally Based Sural Flap for the Reconstruction of Ankle and Foot Defects in Pediatric Patients[J].Ann Plast Surg,2016,77(1):97-101.
[8]Zheng L,Zheng J,Dong ZG.Reverse sural flap with an adipofascial extension for reconstruction of soft tissue defects with dead spaces in the heel and ankle[J].Eur J Trauma Emerg Surg,2016,42(4):503-511.
[9]杨润功,朱加亮,杨林,等.微创切取腓动脉终末穿支蒂腓肠神经营养血管皮瓣修复足踝部软组织缺损[J].中国骨与关节杂志,2015,30(6):443-446.
[10]周廷玉,喻爱喜,Zhou Tingyu,等.负压引流结合腓肠神经营养血管皮瓣修复足踝部慢性感染创面58例治疗体会[J].中国综合临床,2016,32(8):720-722.
[11]胡永福,何智萍,陈万国,等.腓肠神经营养血管皮瓣修复足踝部软组织缺损创面[J].临床骨科杂志,2016,19(1):72-74.
[12]潘敬舜,刘生和.改良腓肠神经营养血管逆行皮瓣修复踝部组织缺损中的临床运用[J].创伤外科杂志,2016,18(4):214-216.
[13]尹文化,雷英,马国栋,等.足底内侧皮瓣在足踝部皮肤软组织缺损修复中的应用[J].中国综合临床,2015,31(3):203-205.
[14]郑润泉,邹林,陈晨,等.邻近逆行穿支带蒂双皮瓣修复足部贯通伤的临床疗效[J].骨科,2017,8(1):12-15.
[15]于德军,刘丽晶,张阿新,等.腓肠神经营养血管皮瓣联合万古霉素硫酸钙骨水泥植入治疗胫骨慢性骨髓炎的疗效分析[J].中国现代医学杂志,2016,26(14):122-124.
[2]刘伟涛.腓肠神经营养血管皮瓣修复小腿及足踝部皮肤软组织缺损[J].临床和实验医学杂志,2017,16(19):1962-1965.
[3]周萍,桂程丽,龚晓丽.VSD引流配合远端蒂腓肠神经营养血管皮瓣转移修复足踝部软组织缺损的临床护理[J].河北医药,2015,37(3):467-469.
[4]徐鹏,刘延辉,俞伟忠,等.负压封闭引流联合小腿远端蒂岛状皮瓣治疗足踝部软组织缺损[J].实用手外科杂志,2015,29(3):272-273.
[5]朱晓浩,陈卓,王雪丽,等.腓肠神经营养血管逆行岛状皮瓣治疗严重小腿远端及足踝部损伤[J].局解手术学杂志,2017,26(8):620-623.
[6]曲新强,刁雷鹏,刘兴龙,等.负压封闭引流术结合腓肠神经营养皮瓣治疗外伤性跟腱外露[J].实用医药杂志,2015,14(5):441-442.
[7]Zheng H,Liu J,Dai X,et al.The Distally Based Sural Flap for the Reconstruction of Ankle and Foot Defects in Pediatric Patients[J].Ann Plast Surg,2016,77(1):97-101.
[8]Zheng L,Zheng J,Dong ZG.Reverse sural flap with an adipofascial extension for reconstruction of soft tissue defects with dead spaces in the heel and ankle[J].Eur J Trauma Emerg Surg,2016,42(4):503-511.
[9]杨润功,朱加亮,杨林,等.微创切取腓动脉终末穿支蒂腓肠神经营养血管皮瓣修复足踝部软组织缺损[J].中国骨与关节杂志,2015,30(6):443-446.
[10]周廷玉,喻爱喜,Zhou Tingyu,等.负压引流结合腓肠神经营养血管皮瓣修复足踝部慢性感染创面58例治疗体会[J].中国综合临床,2016,32(8):720-722.
[11]胡永福,何智萍,陈万国,等.腓肠神经营养血管皮瓣修复足踝部软组织缺损创面[J].临床骨科杂志,2016,19(1):72-74.
[12]潘敬舜,刘生和.改良腓肠神经营养血管逆行皮瓣修复踝部组织缺损中的临床运用[J].创伤外科杂志,2016,18(4):214-216.
[13]尹文化,雷英,马国栋,等.足底内侧皮瓣在足踝部皮肤软组织缺损修复中的应用[J].中国综合临床,2015,31(3):203-205.
[14]郑润泉,邹林,陈晨,等.邻近逆行穿支带蒂双皮瓣修复足部贯通伤的临床疗效[J].骨科,2017,8(1):12-15.
[15]于德军,刘丽晶,张阿新,等.腓肠神经营养血管皮瓣联合万古霉素硫酸钙骨水泥植入治疗胫骨慢性骨髓炎的疗效分析[J].中国现代医学杂志,2016,26(14):122-124.