封闭式负压引流技术联合皮瓣修复下肢皮肤软组织缺损  

REPAIR OF SKIN AND SOFT TISSUE DEFECTS OF LOWER LIMBS WITH VACUUM SEALING DRAINAGE COMBINED WITH FLAPS

作　　者：黎晓华[1] 王惠东[2] 张长青[1] 陈铿[2] 庄蕾[2] 丁宝志[2] 

机构地区：[1]上海交通大学附属第六人民医院骨科,上海200233 [2]上海交通大学医学院附属第三人民医院骨科

出　　处：《中国修复重建外科杂志》2010年第6期722-725,共4页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：上海市卫生局重点专科发展基金项目(2005-Ⅱ-003)~~

摘　　要：目的探讨封闭式负压引流技术(vacuum sealing drainage,VSD)联合皮瓣治疗下肢皮肤软组织缺损的适应证、方法及临床疗效。方法回顾分析2006年6月-2009年11月,应用VSD联合皮瓣修复5例下肢皮肤软组织缺损患者(VSD组)临床资料,并与同期单纯皮瓣修复的10例下肢皮肤软组织缺损患者(非VSD组)进行比较。VSD组:男3例,女2例;年龄32～69岁,平均46岁。车祸伤3例,截肢术后皮肤坏死1例,骨折术后钢板外露1例。其中小腿下段1例,足踝2例,足背1例,前足1例。软组织缺损范围6.5cm×6.0cm～23.0cm×17.0cm。受伤至入院时间2h～2个月。非VSD组:男5例,女5例;年龄23～58岁,平均50岁。车祸伤6例,地震挤压复合伤1例,骨髓炎感染创面1例,骨折术后钢板外露2例。其中小腿下段1例,足踝3例,前足及足背4例,足跟2例。软组织缺损范围4cm×4cm～20cm×12cm。受伤至入院时间1h～2个月。两组患者一般资料比较,差异无统计学意义(P>0.05),具有可比性。结果 VSD组修复术前住院时间为(11.8±9.5)d,修复术后住院时间为(35.4±28.3)d,总住院时间(47.2±35.8)d,切取皮瓣面积(232.8±142.0)cm2,VSD治疗后创面感染率为0;非VSD组分别为(25.8±12.4)d,(33.9±28.1)d、(59.7±32.4)d、(97.3±93.6)cm2,常规抗感染治疗8～14d后创面感染率为80%。两组修复术前住院时间及皮瓣面积比较,差异有统计学意义(P<0.05);修复术后住院时间、总住院时间比较,差异均无统计学意义(P>0.05)。皮瓣修复术后VSD组1例、非VSD组2例皮瓣出现皮缘部分坏死,清创植皮或直接缝合后创面愈合良好;其余皮瓣全部成活,创面Ⅰ期愈合。供区切口均Ⅰ期愈合,植皮顺利成活。两组患者均获随访,随访时间5～41个月,平均22.1个月。两组皮瓣与周围皮肤色泽、质地相似,皮瓣受力处无破溃,无臃肿。结论 VSD联合皮瓣修复对及时控制创伤后下肢皮肤软组织缺损感染、改善创面血运、缩短术前准备时间、及�Objective To explore the feasibility,indications,and effects of vacuum sealing drainage（VSD） combined with flaps for repairing skin and soft tissue defects of lower limbs.Methods From June 2006 to November 2009,15 patients with skin and soft tissue defects of lower limbs were treated with VSD combined with flaps（VSD group,n=5） and only flaps（non-VSD group,n=10）.In VSD group,there were 3 males and 2 females with an average age of 46 years（range,32-69 years）,including 3 cases of traffic accident injury,1 case of skin necrosis after amputation,and 1 case of plate exposure after operation.The locations were lower leg in 1 case,ankle in 2 cases,dorsum of foot in 1 case,and forefoot in 1 case.The defect size ranged from 6.5 cm × 6.0 cm to 23.0 cm × 17.0 cm.The disease course ranged from 2 hours to 2 months.In nonVSD group,there were 5 males and 5 females with an average age of 50 years（range,23-58 years）,including 6 cases of traffic accident injury,1 case of crush injury in earthquake,1 case of osteomyelitis,and 2 cases of plate exposure after operation.The locations were lower leg in 1 case,ankle in 3 cases,forefeet and dorsum of feet in 4 cases,and heel in 2 cases.The defect size ranged from 4 cm × 4 cm to 20 cm × 12 cm.The disease course ranged from 1 hour to 2 months.There was no significant difference in general data between 2 groups（P 〉0.05）.Results In VSD group,the preoperative hospitalization days,postoperative hospitalization days,and total hospitalization days were（11.8 ± 9.5）,（35.4 ± 28.3）,and（47.2 ± 35.8） days,respectively;the size of flap was（232.8 ± 142.0） cm2;and the infection rate after VSD-use was 0.In non-VSD group,the preoperative hospitalization days,postoperative hospitalization days,and total hospitalization days were（25.8 ± 12.4）,（33.9 ± 28.1）,and（59.7 ± 32.4） days,respectively;the size of flap was（97.3 ± 93.6） cm2;and the infection rate after 8 to 14 days of regular therapy was 80%.There were significant differences in the pre

关 键 词：封闭式负压引流技术 皮瓣 下肢软组织缺损 修复 

分 类 号：R658[医药卫生—外科学]