改良封闭负压引流技术在腹部皮瓣供瓣区的临床应用  

Clinical application of the improved vaccum sealing drainage in donor site of abdominal flap

作　　者：赵宇辉[1] 李莉[1] 刘淑岩[1] 刘媛媛[1] 张向飞[1] 

机构地区：[1]唐山市工人医院烧伤整形科,河北唐山063000

出　　处：《中国美容医学》2013年第1期130-132,共3页Chinese Journal of Aesthetic Medicine

摘　　要：目的:探讨改良封闭负压引流(vaccum seal i ng drai nage,VSD)技术在腹部皮瓣供瓣区应用的临床效果。方法:选择2010年2月～2012年1月期间行腹部皮瓣修复手或上肢创面的患者14例,创面大小为15cm×10cm～9cm×5cm。创面清创后行腹部随意皮瓣转移,皮瓣长宽比例在2:1以内,面积15cm×12cm～9cm×7cm。供瓣区及皮瓣蒂部裸露区应用医用海绵覆盖,医用半透性粘贴薄膜封闭整个术区。连接负压吸引装置,腹带固定患肢。术后第2天,在医用海绵的远端,刺入静脉输液针,每天500ml生理盐水持续进行灌洗。皮瓣移植14～18天后行皮瓣断蒂术,术后10～12天切口拆线。结果:所有病例皮瓣全部成活,切口甲级愈合13例,乙级愈合1例。9例患者供瓣区通过局部皮瓣转移后,直接缝合,未予植皮。4例患者行局部部分拉拢缝合,缩小创面后,移植皮片覆盖。植皮面积8cm×5cm～5cm×3cm。无VSD装置更换病例。3例患者术后当天出现负压引流区轻度疼痛。其余患者无不适反应。所有病例静脉输液针穿刺孔未发生可见漏气现象,未影响负压引流的正常进行。结论:改良VSD技术延长了VSD装置的使用时间,明显减少了VSD的并发症;改良VSD技术减少了腹部供瓣区的植皮率,降低了术区感染率,简化了腹部皮瓣手术过程。Objective To explore the clinical effects of Improved vaccum sealing drainage （VSD） applications in donor site of abdominal flap. Methods 14 patients with hand or upper extremity wounds repaired by abdominal flap from February 2010 to January 2012 were enrolled in the study. The wounds measured from 15cm×10cm to 9cm×5cm were covered with abdominal random skin flap. The length to width ratio of the flaps were less than 2：1 and the area of flaps ranged from 15cm× 12cm to 9cm×7cm. The donor site and the exposed area of the pedicle were covered by medical sponge and the medical semipermeable paste film closed the entire surgery area. Then connected suction device and cummerbund fixed limb. After 2 days, the infusion needles connecting infusion set penetrated the remote of medical sponge, given daily 500ml saline continuous lavage. The pedicle division surgery underwent 14 to 18 days after flap transplantation and incision stitches underwent 10 to 12 days after pedicle division surgery. Results In all cases the flaps survived. 13 cases in A grade incision healing, one case in B grade. 9 patients donor site sutured directly by local flap. 4 patients underwent partial part of the suture, the remaining wound covered by skin grafts. Skin graft area ranged 8cm x5cm to 5cm x3cm. There no VSD device replacement cases. Three cases endured a mild pain of the suction drainage area at first postoperative day. The remaining patients had no discomfort. In all cases, visible leakage phenomenon did not occur and it did not affect the normal suction drainage. Conclusion Improved VSD extends the period of VSD application and significantly reduces it＇s complications. The skin grafting rate of donor site is significantly decreased. It reduce the infection rate of the surgery and simplifies the process of abdominal skin flap surgery.

关 键 词：VSD技术 腹部皮瓣 供瓣区 并发症 烧伤 手 创面修复 

分 类 号：R622[医药卫生—整形外科]