套管负压吸引结合挂针缝合固定技术在下肢大面积潜行皮肤撕脱伤中的临床应用  

Clinical application of cannula negative pressure suction combined with hanging needle suture and fixation technique in the treatment of large-area latent skin avulsion injury of the lower limbs

作　　者：张远军[1] 黎建义[1] 曾东杰 张绍海[1] 苏永康[1] 郑臣校[1] ZHANG Yuanjun;LI Jianyi;ZENG Dongjie;ZHANG Shaohai;SU Yongkang;ZHENG Chenxiao(Department of Microtrauma and Orthopedics Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan 528400, Guangdong Province, China)

机构地区：[1]广东省中山市中医院显微创伤骨科

出　　处：《西南医科大学学报》2019年第5期440-444,共5页Journal of Southwest Medical University

摘　　要：目的:探讨套管负压吸引结合挂针缝合固定技术的临床疗效。方法:采用套管负压吸引结合挂针缝合技术治疗下肢大面积潜行皮肤撕脱伤,观察其临床疗效。结果:本组患者8例全都获得随访,所有患者急诊手术后套管负压吸引挂针缝合固定的潜行套脱区皮肤均基本成活,3例患者仅余留散在小于12cm表皮坏死创面经换药后痊愈;游离皮片植皮区皮片成活率70%~80%3例,经行二次清创再次植皮后痊愈;其中2例涉及足踝及足跟部皮肤脱套伤患者术后发生皮肤缺血坏死,予以二期行胫后动脉穿支隐神经营养皮瓣、腓肠神经营养皮瓣修复后获得痊愈。所有患者均未发生明确深层组织感染坏死、骨髓炎、败血症、气性坏疽、大出血等严重并发症,经随访2~8月,患肢局部散在疤痕增生,感觉基本恢复;游离植皮区患肢肤色留有不同程度色素沉着,潜行撕脱区皮肤颜色良好,外观基本正常,感觉满意。结论:积血积液残留和缺乏合理有效固定,是导致潜行套脱区皮肤大面积坏死的重要原因;彻底清创、有效判定皮肤血运边界、持续均匀有效的引流及合理有效的固定,是治疗大面积潜行皮肤脱套伤取得良好疗效的关键。套管负压吸引结合挂针缝合技术有效解决了皮下引流与撕脱皮肤固定难题,大大提高了皮肤存活率,费用低廉,疗效较满意,值得临床推广使用。Objective: To investigate the clinical efficacy of cannula negative pressure suction combined with hanging needle suture and fixation technique in the treatment of large-area latent skin avulsion injury of the lower limbs. Methods: Cannula negative pressure suction combined with hanging needle suture technique was adopted to treat large-area latent skin avulsion injury of the lower limbs, and its clinical efficacy was evaluated. Results: All the eight patients in this group were followed up. After an emergency operation, the skin in the latent degloving area of all the patients treated with cannula negative pressure suction combined with hanging needle suture and fixation technique basically survived. Three patients only had sporadic epidermal necrosis wounds of less than 1×1 cm in size, which healed after dressing change. Three patients had a skin graft survival rate of 70%~80% in the free skin grafting area and recovered after a second debridement and skin grafting. Two of the above patients who suffered from skin degloving injury of the heel and ankle experienced postoperative skin ischemic necrosis and recovered after secondary repair with saphenous neurovascular flaps supplied by the perforating branch of the posterior tibial artery and sural neurovascular flaps. No patients experienced serious complications such as infection and necrosis of deep tissue, osteomyelitis, sepsis, gas gangrene, or massive hemorrhage. During the follow-up of 2-8 months, localized and sporadic cicatricial hyperplasia occurred in the affected limbs and the sensation was basically recovered.The skin color of the affected limbs with free skin grafting exhibited varying degrees of pigmentation. The skin color of latent avulsion area was good, the appearance was basically normal, and the sensation was satisfactory. Conclusion: Residual hematocele and effusion and lack of reasonable and effective fixation are the main causes of large-area skin necrosis in the latent degloving area. Thorough debridement, effective assessment of blood su

关 键 词：套管负压吸引 挂针缝合固定技术 大面积潜行皮肤撕脱伤 

分 类 号：R642[医药卫生—外科学]