序贯封闭式负压引流技术与带蒂皮瓣治疗儿童后足摩托车轮辐伤  

SEQUENTIAL THERAPY OF VACUUM SEALING DRAINAGE AND PEDICLED FLAP TRANSPLANTATION FOR CHILDREN WITH MOTORCYCLE SPOKE HEEL INJURY

作　　者：董福[1] 朱金荣[1] 李云峰[1] 陆春[1] 

机构地区：[1]北海市人民医院骨科一区,广西北海536000

出　　处：《中国修复重建外科杂志》2015年第4期462-466,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨儿童后足摩托车轮辐伤的热损伤特点,总结序贯封闭式负压引流技术(vacuum sealing drainage,VSD)与带蒂皮瓣修复此类损伤的疗效。方法 2010年1月-2014年1月,收治15例单侧后足摩托车轮辐伤患儿。男11例,女4例;年龄3~8岁,平均5.7岁。受伤至入院时间为3~7 d,平均4.9 d。创面部位:单纯足后跟8例,足后跟与外踝2例,内踝与足跟内侧4例,内外踝与足后跟1例。均存在不同程度皮肤、肌腱及骨骼缺损,其中皮肤软组织缺损范围为3 cm×3 cm^13 cm×6 cm。入院后行创面清创,经2~3次VSD治疗后创面清洁、肉芽生长良好后,行皮瓣修复术,其中8例吻合皮神经。皮瓣切取范围为4 cm×4 cm^14 cm×7 cm。结果术后13例皮瓣完全成活,2例皮瓣边缘部分坏死;创面Ⅰ期愈合。供区植皮均成活。术后15例患儿均获随访,随访时间9~21个月,平均13个月。9例皮瓣轻度臃肿,6例中度臃肿。13例患儿足部负重、行走基本恢复正常,2例轻度跛行。8例吻合皮神经皮瓣术后6个月浅感觉均恢复至S3,无皮瓣磨损;7例未吻合皮神经皮瓣术后6个月浅感觉恢复至S2,2例出现皮瓣边缘磨损。术后8个月,根据美国矫形足踝协会(AOFAS)踝-后足评分评价踝关节功能,获优13例,良2例,优良率100%。结论儿童后足摩托车轮辐伤属高能量损伤,合并热损伤,序贯VSD与带蒂皮瓣修复可获较好疗效。Objective To investigate the clinical characteristics of motorcycle spoke heel injury and the effectiveness of sequential therapy of vacuum sealing drainage（VSD） and pedicled flap transplantation for treating motorcycle spoke heel injury in children. Methods Between January 2010 and January 2014, 15 children（aged from 3 to 8 years, 5.7 years on average） with motorcycle spoke heel injury received sequential therapy of VSD and pedicled flap transplantation. The interval from injury to admission was 3-7 days, with an average of 4.9 days. The locations were the heel in 8 cases, the heel and lateral malleolus in 2 cases, and the medial malleolus and medial heel in 4 cases, and the medial and lateral malleolus and heel in 1 case. The patients had different degrees of defects of the skin, tendon, and bone. The skin defect size ranged from 3 cm×3 cm to 13 cm×6 cm. VSD was applied for twice in 13 cases and three times in 2 cases. Reversed flow sural flap was applied in 8 cases, lateral supramalleolar flap in 2 cases, medial supramalleolar perforator-based flaps in 4 cases, and posterior tibial artery flap in 1 case. Eight pedicled flaps with neuroanastomosis were selected according to the wound characteristics. The flap size ranged from 4 cm×4 cm to 14 cm×7 cm. Results Of 15 cases, 13 flaps survived well except that two had partial skin necrosis at the distal site. Primary healing was obtained, and skin graft at donor site survived. The patients were followed up 9-21 months（mean, 13 months）. Mild and moderate bulky flaps were observed in 9 cases and 6 cases respectively. Of 15 cases, 13 could walk with weight loading, and 2 had slight limping. Superficial sensation recovered to S3 in 8 patients undergoing neuroanastomosis, and recovered to S2 in 7 patients not undergoing neuroanastomosis at 6 months after operation. According to AOFAS evaluation system for Ankle-Hindfoot, the results were excellent in 13 cases and good in 2 cases, with an excellent and good rate of 100% at 8 months after operation. Conclus

关 键 词：后足轮辐伤 热损伤 封闭式负压引流技术 带蒂皮瓣 儿童 

分 类 号：R726.5[医药卫生—儿科]