改良置线皮肤牵引法治疗皮肤慢性溃疡  

Clinical effect of modified skin traction in treating chronic skin ulcer

作　　者：牛占国[1] 万里[1] 陈晓武[1] 黄静[1] 叶茂球 叶东成 Niu Zhanguo;Wan Li;Chen Xiaowu;Huang ring;Ye Maoqiu;Ye Dongcheng(Department of Burn and Plastic Surgery,Dongguan People＇s Hospital,Dongguan 523059,China)

机构地区：[1]东莞市人民医院烧伤整形科,523059

出　　处：《中华整形外科杂志》2018年第10期852-855,共4页Chinese Journal of Plastic Surgery

基　　金：东莞市科技计划医疗卫生类科研项目（20131051010109）

摘　　要：目的探讨对慢性创面创缘置入丝线后针脚处加衬棉垫进行牵引治疗的临床效果。方法2009年1月至2016年8月收治21例患者共计31处创面，采用创缘内置线法进行持续创缘皮内牵引术治疗，在创缘内置入丝线时针脚处加衬棉垫，将创缘两侧缝线以一定拉力向创面中心牵拉，在两侧皮缘可基本对合时直接缝合伤口。结果31处创面全部愈合，无一例皮缘坏死。5例发生针孔割裂伤，经换药后愈合。愈合时间为（43.24±11.46） d，针脚处大多不留瘢痕，或仅遗留轻微瘢痕。与用胶管加衬于针脚的方法相比，两者愈合时间差异无统计学意义（P＝0.119），但使用棉垫发生的针孔割裂伤更少（P＝0.046）。结论置入丝线后针脚处加衬棉垫能够有效缓冲丝线对创缘皮肤的切割力、保护牵引点，便于更换，是一种治疗慢性创面的较好方法。Objective To explore the clinical effect of cotton pads under stitches when intradermal traction with sutures is used to repair of chronic wounds.Methods From January 2009 to August 2016, 21 patients with 31 wounds were treated by continuous intradermal traction. Wound edges were sutured with 2-0 silk thread in horizontal mattress fashion, but not tied. Then small cotton pads were put under stitches to protect the skin around the wound. After that, the sutures on both sides of the wound edges were pulled to the center of the wound with a certain force. And the wound was sutured finally when the skin on both sides of the wound was closed enough.Results All of 31 wounds healed without necrosis of the skin margin and 5 cases of lacerated wound caused by silk thread healed after dressing change. The healing time was （43.24±11.46） days, and there was scarcely hypertrophic scar at the stitches. This method was compared with the previous method of protecting stitches with silicone tubes（ referring to past data）. There was no significant difference in the healing time between the two methods （P=0.119）, and less laceration occurred under the stitches with cotton pads （P=0.046）.Conclusions It is a commendable method for treating chronic wounds to put cotton pads under the stitches while tracting the wound edges with sutures. It can effectively cushion the cutting force of the silk thread, protect the traction point and facilitate the replacement of the pads.

关 键 词：慢性溃疡 丝线 皮肤牵引 缝合 

分 类 号：R632.1[医药卫生—外科学]