负压封闭引流联合邮票植皮治疗软组织感染伴缺损24例  

Vacuum sealing drainage combined with stamp skin grafting in the treatment of 24 cases suffering from soft tissue infection with defect

作　　者：钟文龙[1] 杨思敏 郭再冉 王新卫[2] ZHONG Wen-long;YANG Si-min;GUO Zai-ran;WANG Xin-wei(Graduate School of Henan University of Chinese Medicine,Zhengzhou 450046,China;The First Department of Osteomyelitis,Luoyang Orthopedic Hospital ofHenan Province,Luoyang 471002,China)

机构地区：[1]河南中医药大学研究生院,河南郑州450046 [2]河南省洛阳正骨医院骨髓炎一科,河南洛阳471002

出　　处：《河北医科大学学报》2018年第11期1296-1299,共4页Journal of Hebei Medical University

摘　　要：目的观察负压封闭引流(vacuum sealing drainage,VSD)装置联合邮票植皮在治疗皮肤软组织感染伴缺损中的临床效果。方法选择河南省洛阳正骨医院收治的24例皮肤感染伴缺损的患者,经治疗生命体征平稳后,Ⅰ期行清创手术,使用VSD持续吸引创面5～14d(更换1～2次),待创面肉芽组织新鲜无感染时,Ⅱ期取大腿内侧中厚皮片,切割成大小约0.5cm×0.5cm邮票状皮片,皮片以间2mm距离贴满创面,网眼凡士林纱布覆盖,无菌敷料加压包扎,7d后打开敷料观察。结果所有患者Ⅰ期治疗后肉芽组织呈颗粒状、鲜红、无感染;Ⅱ期植皮术后2周创面情况:23例优,1例良,患处均无疼痛感。1例患者因活动不当造成部分皮片滑动、重叠而使创面未能全部覆盖,后期经多次换药,创面愈合;1例创面边缘出现少量皮片变干、活性较差(未坏死),涂以薄层美宝湿润烧伤膏而自行成活。3～12个月随访,植皮区颜色、弹性、感觉及关节活动均正常,无继发皮肤感染、坏死、肢体重度残疾及二次手术。结论采用VSD联合邮票植皮术治疗四肢及躯干皮肤软组织感染伴缺损具有操作简便、住院时间短、费用低、疗效确切、并发症少等优点,值得临床推广。Objective To observe the clinical efficacy of vacuum sealing drainage（VSD） combined with stamp skin grafting in the treatment of soft tissue infections with defects.Methods Twenty-four patients were selected with skin infections and defects admitted to Luoyang orthopedic hospital of Henan province. After vital signs became stable, all patients were received debridement surgery in the first stage, and VSD was used to continuously press and suck the wound for 5 to 14 days（replace one or two times） until the wound granulation tissue was fresh without infection. In the second stage, the intermediate split thickness skin graft was taken from inner thigh and was cut into stamp-shaped pieces of skin about 0.5 cm×0.5 cm. The wound was attached with skin pieces at a distance of 2 mm, then was covered by the meshy vaseline gauze. And the sterile dressing was used for pressurized bandage. After 7 days, the dressing was observed.Results Granulation tissues of all patients were granular, bright red, and free from infection after the first stage of treatment. Two weeks after stage Ⅱ skin grafting： 23 cases were excellent, 1 case was good, and there was no pain in the affected area. One patient failed to cover the wound completely because of sliding and overlapping of some skin flaps due to inappropriate movement, and the wound healed after repeated dressing changes in the later period. One patient had a small quantity of skin pieces that were dry and had poor activity（not necrotic） on the edge of the wound. They was coated with a thin layer of MEBO moist burn cream and survived on its own. After 3 to 12 months of follow-up, the color, elasticity, sensation and joint activity of the skin graft area were normal without secondary skin infection, necrosis, limb weight disability and secondary surgery.Conclusion VSD combined with stamp skin grafting in the treatment of skin and soft tissue infections of extremities and trunk with defects has the advantages of simple operation, short hospitalization time, low co

关 键 词：感染 皮肤移植 负压伤口疗法 

分 类 号：R632[医药卫生—外科学]