自体皮肤冷冻保存回植技术在上肢脱套伤治疗中的应用  

Cryopreservation-replantation of autologous skin in the treatment of cutaneous degloving injury of upper limb

作　　者：孙玉亮 林俊豪[1] 崔宜栋 裴艳涛[1] 王俊涛[1] 王刚[1] 许庆家[1] 朱磊[1] SUN Yuliang;LIN Junhao;CUI Yidong;PEI Yantao;WANG Juntao;WANG Gang;XU Qingjia;ZHU Lei(Department of Orthopedics,Qilu Hospital of Shandong University,Jinan 250012,Shandong,China)

机构地区：[1]山东大学齐鲁医院骨科,山东济南250012

出　　处：《山东大学学报（医学版）》2018年第9期35-40,共6页Journal of Shandong University:Health Sciences

基　　金：山东省重点研发计划(2015GSF118117);山东大学齐鲁医院科研基金/山东大学基本科研业务费专项资金(2015QLMS27);山东省自然科学基金博士基金(BS2013YY005);国家自然科学基金青年基金(81302189)

摘　　要：目的研究自体皮肤深低温冷冻保存回植技术在上肢脱套伤治疗中的应用。方法 2016年1月至2017年6月利用皮肤深低温冷冻回植技术治疗上肢脱套伤患者10例,其中男6例,女4例,27~77岁,平均46岁。受伤原因:车祸伤4例,机器挤伤6例。受伤部位:单侧前臂6例,单侧手部4例。皮肤离体2~14 h,平均5.8 h,冻存8~38 d,平均24.8 d,回植皮肤面积3 cm×5 cm^20 cm×24 cm。撕脱皮肤均因创面污染严重,组织挫伤重,局部骨质肌腱外露无法一期回植,行深低温冷冻保存,二期经清创手术后,行原位回植或异位植皮。结果回植皮肤中,1例因感染完全坏死,其他存活50%~100%,3例术后经再次植皮创面痊愈。术后均随访6个月以上,回植皮肤有不同程度色素脱失,无毛发生长,但皮肤质地柔软,弹性良好,浅感觉有不同程度恢复。结论应用深低温冷冻技术成功保存脱套伤患者的撕脱皮肤,可以为创面的肉芽修复提供充足的时间,回植皮肤成活率高,长期随访皮肤质地及功能满意,基本满足修复上肢创面的要求,同时也可避免或减少患者自体取皮,减轻患者的痛苦及经济负担。Objective To explore the application of cryopreservation-replantation technique of autologous skin in the treatment of degloving injuries of upper limbs. Methods The clinical data of 10 patients with upper limb degloving injuries during January 2016 and June 2017 were retrospectively analyzed,including 6 males and 4 females,averaged 46（ranging from 22 to 77） years. The injuries were caused by traffic accidents in 4 cases,and by machine extrusion in 6 cases. The location of injuries involved unilateral forearm in 6 cases and unilateral hand in 4 cases. The skins stayed in vitro for 2 to 14（ average 5. 8） hours and were cryopreserved for 8 to 38（ average 24. 8） days. The size of cryopreserved skin was 3 cm × 5 cm to 20 cm × 24 cm. The degloved skins could not be transplanted immediately due to severe contamination,tissue contusion and local bone tendon exposure. After cryopreservation and debridement,they were transplanted in situ or ectopically. Results Of the 10 cases,1 case developed necrosis due to infection,others survived50% - 100%,3 received a second skin grafting and recovered well. During the 6-month follow-up,the replanted skin was soft and resilient,the sensation recovered at different levels,but the skin showed different degrees of depigmentation,and there was no hair growth. Conclusion Cryopreservation-replantation technique of autologous skin provides time for wound preparation. The survival rate of replanted skin is high,and the resilience and function are satisfying.Besides,this technique can utilize the degloved skins efficiently,decrease the donor site area,relieve patients＇ pain and reduce financial burden.

关 键 词：皮肤冷冻 深低温 回植 脱套伤 

分 类 号：R641[医药卫生—外科学]