早期去除坏死皮肤结合人工真皮及皮片移植治疗儿童手部皮肤坏死性挫伤  

Early removal of necrotic skin plus with artificial dermal and skin grafts for cutaneous necrotic contusion in children’s hands

作　　者：朱振洪[1] 殷炜[1] 马周瑞[1] 胡官鸿 黄志见[1] Zhu Zhenhong;Yin Wei;Ma Zhourui;Hu Guanhong;Huang Zhijian(Department of Burn&Plastic Surgery,Affiliated Children's Hospital,Suchow University,Suzhou 215000,China)

机构地区：[1]苏州大学附属儿童医院烧伤整形外科

出　　处：《临床小儿外科杂志》2019年第11期964-967,共4页Journal of Clinical Pediatric Surgery

基　　金：苏州市科技发展计划项目(编号:SYSD2019118)

摘　　要：目的探讨早期去除因挫伤导致的儿童手部全层皮肤坏死并应用人工真皮促进创面肉芽组织生长的临床疗效,为尽早植皮创造条件。方法2016年2月至2018年8月,苏州大学附属儿童医院烧伤整形外科共收治儿童手部挫伤致皮肤全层坏死患儿26例,均于受伤后2~72 h(中位值时间16.2 h)内于麻醉下行手部坏死皮肤削除,再以人工真皮覆盖创面,7~10 d后行创面全厚皮片移植,植皮术后指导康复训练,并随访评价手部功能。结果早期清创结合人工真皮及皮片移植治疗儿童手部皮肤坏死性挫伤治疗进程紧凑,植皮成活率高。本组26例中15例移植皮肤全部成活,11例仅出现部分植皮区创缘皮肤坏死,经换药后愈合。26例经3~15个月(中位值10.5个月)随访,根据美国手外科协会手指总活动度(total active motion,TAM)评价标准,手指活动优良率达88.1%。结论早期清创结合人工真皮及皮片移植治疗儿童手部皮肤坏死性挫伤可缩短手部皮肤坏死后愈合时间,提高游离皮片移植的存活率,保证手部创面修复的效果和手部功能,值得在儿童手部皮肤坏死性挫伤中推广应用。Objective To explore early removal of full-thickness necrotic skin of children s hands after contusion,use artificial dermis for promoting the growth of wound granulation tissue and create conditions for early skin grafting.Methods From February 2016 to August 2018,26 children of full-thickness dermal necrosis caused by hand contusion.Necrotic skin was removed under anesthesia at a median time of 16.2(2-72)hours after injury and the wound covered with artificial skin graft.Fully thickened skin was grafted after 7-10 days.Rehabilitation training was performed and followed by evaluations of hand function.Results Early removal of necrotic skin combined with artificial dermis for cutaneous necrotic contusion in children s hands,the treatment process was compact with a high survival rate of skin graft.The outcomes were survival of transplanted skin(n=15)and skin necrosis in skin graft area(n=11).The median follow-up period was 10.5(3-15)months.Based upon to the finger movement function standard of American Hand Surgery Association,the fine rate of total active motion(TAM)was up to 88.1%.Conclusion Early removal of necrotic skin plus with artificial dermis for cutaneous necrotic contusion in hands can shorten the healing time,improve the survival rate of free skin graft and ensure the effect of hand wound repair and hand function in children.It is worthy of wider application.

关 键 词：手 皮肤 坏死 真皮/移植 清创术 儿童 

分 类 号：R622.1[医药卫生—整形外科] R322.991[医药卫生—外科学]