封闭式负压引流技术在重度皮肤潜行性剥脱伤中的应用  

APPLICATION OF VACUUM SEALING DRAINAGE IN SEVERE SKIN CLOSED INTERNAL DEGLOVING INJURY

作　　者：牛朝阳 邓友章[2] 孙永强 王上增 

机构地区：[1]河南中医学院第二附属医院骨科,郑州450002 [2]成都中医药大学附属医院骨科

出　　处：《中国修复重建外科杂志》2012年第1期61-63,共3页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨封闭式负压引流技术(vacuum sealing drainage,VSD)联合中厚皮片回植治疗重度皮肤潜行性剥脱伤(closed internal degloving injury,CIDI)的疗效。方法 2008年7月-2011年4月,收治16例重度皮肤CIDI患者。男11例,女5例;年龄17～56岁,平均28岁。均为交通事故伤。受伤至手术时间2～8 h,平均5 h。皮肤剥脱部位:上肢3例,下肢13例。皮肤剥脱范围为5%～12%体表面积,平均7%体表面积。剥脱皮肤均有不同程度污染。彻底清创后,切取剥脱皮肤制备为断层中厚皮片原位回植,术后应用VSD治疗。结果 14例经7 d VSD治疗后,回植皮肤顺利成活;2例VSD治疗7 d后约0.3%体表面积回植皮肤发生坏死,再次彻底清创后VSD联合抗生素治疗,7 d后游离植皮修复后愈合。患者均获随访,随访时间6～18个月,平均12个月。肢体外观满意,无明显瘢痕形成,血运及感觉正常;关节均活动良好。结论重度皮肤CIDI患者剥脱皮肤回植后应用VSD治疗,可改善肢体局部血液循环,促进回植皮肤成活,缩短回植皮肤成活时间,临床疗效满意。Objective To investigate the effectiveness of the vacuum sealing drainage（VSD） technique with split middle thickness skin replantation for the treatment of severe skin closed internal degloving injury（CIDI）.Methods Between July 2008 and April 2011,16 patients with severe skin CIDI were treated.There were 11 males and 5 females,aged 17-56 years（mean,28 years）.Injury was caused by traffic accident in all cases.The time between injury and operation was 2-8 hours（mean,5 hours）.Peeling skin parts included the upper limb in 3 cases and the lower limb in 13 cases.The range of skin exfoliation was 5%-12%（mean,7%） of the body surface area with different degree of skin contamination.After thorough debridement,exfoliative skin was made split middle thickness skin graft for in situ replantation,and then VSD was performed.Results After 7 days of VSD therapy,graft skin survived successfully in 14 cases;partial necrosis of graft skin occurred in 2 cases,and was cured after thorough debridement combined with antibiotics for 7 days.All patients were followed up 6-18 months（mean,12 months）.The appearance of the limb was satisfactory without obvious scar formation,and the blood supply and sensation were normal.The joint function was normal.Conclusion For patients with severe skin CIDI,VSD treatment combined with split middle thickness skin replantation can improve the local blood circulation of the limb,promote replantation skin survival,and shorten healing time of wound.The clinical effectiveness is satisfactory.

关 键 词：封闭式负压引流技术 重度皮肤潜行性剥脱伤 皮片回植 创面修复 

分 类 号：R473[医药卫生—护理学]