自制肢体慢性创面闭合装置在瘢痕性下肢创面修复中的应用  

Application of self-made chronic wound closure device in the repair of scarred lower extremity wounds

作　　者：浦绍全 吕乾 赵泽雨 胡丹 陈向[1] 陈汉芬 朱跃良[1] 徐永清[1] PU Shaoquan;Lu Qian;ZHAO Zeyu;HU Dan;CHEN Xiang;CHEN Hanfen;ZHU Yueliang;XU Yongqing(Department of orthopedics,the Joint Service Support Force 920th Hospital of Chinese PLA,Kunming Yunnan,650032,P.R.China)

机构地区：[1]中国人民解放军联勤保障部队第920医院骨科,昆明650032

出　　处：《中国修复重建外科杂志》2019年第2期219-222,共4页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：成都军区医学科学技术研究计划项目(B14012)~~

摘　　要：目的探讨自制肢体慢性创面闭合装置在下肢瘢痕性及复杂皮肤软组织缺损修复中的应用。方法 2014年1月—2017年1月,收治29例下肢复杂骨折合并皮肤软组织缺损患者。其中男19例,女10例;年龄21～66岁,平均31.1岁。致伤原因:交通事故伤14例,高处坠落伤5例,重物挤压伤4例,机器辗压伤4例,骨折术后钢板外露2例。骨折及皮肤缺损部位:小腿胫腓骨骨折并皮肤缺损26例,跖骨骨折并足背皮肤缺损3例。皮肤缺损范围为5 cm×3 cm～18 cm×8 cm。受伤至入院时间5～31 d,平均14.3 d。患者均采取彻底清创、伤口敞开引流,自制肢体慢性创面闭合装置结合Ilizarov牵张技术行皮肤软组织缓慢牵拉。待创面清洁、肉芽组织新鲜,两侧皮肤靠拢后二期根据实际创面大小植皮或直接缝合封闭创面。结果患者术后均获随访,随访时间8～20个月,平均13个月。29例患者经肢体慢性创面闭合装置结合Ilizarov技术牵拉治疗1～2次,平均1.3次后感染得到控制,肉芽组织生长良好。治疗过程中患者疼痛不明显,依从性好。创面均达临床愈合,无皮肤牵拉并发症发生,创面仅形成线状或片状瘢痕。结论自制肢体慢性创面闭合装置修复下肢复杂瘢痕性创面效果较好,且手术难度小,可操作性强。Objective To investigate the effectiveness of self-made limb chronic wound closure device in the treatment of scarred lower limbs and complex skin and soft tissue defects. Methods Between January 2014 and January2017, 29 patients with complex fractures of the lower extremities and skin and soft tissue defects were treated. There were19 males and 10 females with an average age of 31.1 years(range, 21-66 years). The causes of injury included 14 cases of traffic accidents, 5 cases of falling from height, 4 cases of heavy object crushing injury, 4 cases of mechanical crushing injury, and 2 cases of exposed steel plate after fracture. There were 26 cases of calf fracture and skin defect, 3 cases of metatarsal bone fracture and skin defect of the foot. The skin defect ranged from 5 cm×3 cm to 18 cm×8 cm. The time from injury to admission was 5-31 days, with an average of 14.3 days. All patients underwent a thorough debridement,open wound drainage, self-made chronic wound closure device combined with Ilizarov stretching technique for a slow skin and soft tissue traction. After the wound was cleaned up and the granulation tissue was freshened, the skins on both sides were closed, and then proceed to the second stage operation of skin grafting or direct suture closure based on the size of the wound. Results All patients were followed up 8-20 months, with an average of 13 months. Twenty-nine patients were treated with self-made chronic wound closure device combined with Ilizarov technique for 1-2 times with an average of 1.3 times, then the wound infection was controlled and the granulation tissue grew well. In the course of treatment,the pain was not obvious and the patients had good compliance. All patients’ wounds healed clinically without skin traction complications and formed linear or flaky scars. Conclusion The self-made chronic wound closure device is e ffective in repairing complex scarred wounds of lower extremities, and it is easy to operate.

关 键 词：瘢痕性创面 软组织缺损 创面闭合 ILIZAROV技术 

分 类 号：R622[医药卫生—整形外科]