负压封闭引流技术与穿支皮瓣技术联合治疗四肢严重挤压伤  

Application of vacuum scaling drainage technique in perforator flap grafting to repair severely crushed extremities

作　　者：潘朝晖[1] 蒋萍萍[1] 王剑利[1] 薛山[1] 赵玉祥[1] 李洪飞[1] 

机构地区：[1]解放军第八十九医院全军创伤骨科研究所,山东省潍坊市261021

出　　处：《中华创伤骨科杂志》2012年第10期850-853,共4页Chinese Journal of Orthopaedic Trauma

基　　金：军队“十二五”面上课题资助项目（CWS11J245）

摘　　要：目的探讨负脏封川引流（VSD）技术与穿支皮瓣技术联合治疗四肢严重挤压伤合并软组织缺损的疗效。方法自2008年11月至2010年6月采用VSD技术联合穿支皮瓣技术治疗四肢严重挤压伤创面30例，男23例，女7例；年龄18～65岁，平均32．3岁。所有患者在平均使用VSD敷料9．4d后以穿支皮瓣覆盖创面。其中应用股前外侧穿支皮瓣13例，股前外侧穿支皮瓣串联旋髂浅动脉穿支髂骨骨皮瓣5例，股前外侧穿支皮瓣串联旋髂浅动脉穿支皮瓣1例，股前外侧穿支皮瓣与第2足趾组合移植1例，旋髂浅动脉穿支皮瓣3例，带蒂腓动脉外踝后上穿支皮瓣6例，带蒂脐旁穿支皮瓣1例。结果股前外侧皮瓣1例近端边缘坏死，1例发生延迟感染，经换药后愈合，其余患者均一期愈合。5例股前外侧皮瓣供瓣pt前植皮，其余供瓣区直接缝合。所有患者术后获6个月至2年（平均1．2年）随访，皮瓣质地粱软，外形较满意。供区尤癜痕疙瘩形成及瘢痕增牛。二期有4例行肌腱晕建手术，2例行股前外侧皮瓣行修整术，1例行分指术，1例行植骨术。术后于部均恢复握持、夹挹功能，下肢可无痛行走。结论一期清创、行VSD，延期行穿支皮瓣术可安全有效地治疗四肢严霞挤压伤创面。Objective To evaluate the clinical efficacy of vacuum sealing drainage （VSD） technique in perfurator flap grafting to treat severely crushed extremity. Methods From November 2008 to June 2010, VS1） technique was used to manage the woands of 30 consecutive patients with severe injuries at the extremity. They were 23 men and 7 women, aged from 18 to 65 years （average, 32.3 years） . Free or pedicled perforator flaps were used to cower the wounds after an average of 9.4 days following VSD. Free anterolateral thigh pertorator flaps were used in 13 patients; fi＇ee anterolateral thigh perforator flaps were used in 5 in combination with an superficial circumflex iliac artery, in one case in combination with a superficial circumflex lilac artery flap and in one case in combination with the second toe： perforator flaps with superficial circunfflex lilac artery were used in 3 cases： lateral retro-malleolar perfbrator flaps pedicled by peroneal arteh were used in 6 cases： a pedicled pert-umbilicus perforator flap was used in one ease. Results All flaps healed at one stage except one that had marginal necrosis at the proximal part of the anterolateral thigh flap and one delayed intfeclion that responded to dressing. All the donor sites were directly sutm＇ed except 5 donor sites for anterolateral thigh flaps where skin grafling was needed. The mean follow-up of 1.2 years （from 6 months to 2 years） showed that all the flaps were tender and well shaped, without hypertrophic scars or genuine keloids at the donor site. Secnndary tendon reconstruction was performed in 4 patients. Flap defatting was performed in 2 antcrolateral thigh flaps. Finger separation and bone transplantation was performed each in one patient re- spectively. Either grasp and pinch or weight bearing was nearly recovered. Conclusion VSD technique in combination with primary dehridement followed by delayed grafting of perforator flaps is safe and effective in the treatment of severely crushed extremity.

关 键 词：外科皮瓣 引流术 骨折 开放性 显微外科手术 

分 类 号：R473.6[医药卫生—护理学]