在有吻合血管裸露的小创面植皮16例的临床观察  

Clinical study of skin grafting in small wounds with anastomotic vascular exposure:report of 16 cases

作　　者：魏义涛 梅雄军 伍仁娟 钟桂午 梁海华 孙芳芹 Wei Yitao;Mei Xiongjun;Wu Renjuan;Zhong Guiwu;Liang Haihua;Sun Fangqin(Department of Hand and Foot Microsurgery,Chang'an Xin'an Hospial,Dongguan,Guangdong Province 523800,China;Department of Orthopedic,Hospital Attached to Aero Medicine linstitute of PLA,Bejing 100089,China)

机构地区：[1]东莞长安新安医院手足显微外科,广东东莞523880 [2]中国人民解放军空军航空医学研究所附属医院骨科,北京100089

出　　处：《中华显微外科杂志》2019年第6期536-539,共4页Chinese Journal of Microsurgery

基　　金：东莞市社会科技发展(一般)项目(2019507150116151)。

摘　　要：目的探讨在伴有吻合血管裸露的小创面上植皮修复的临床疗效。方法自2011年1月至2018年5月,应用全厚皮片植皮修复血管裸露创面16例,均为血管吻合部位裸露。其中再植加植皮4例,再造加植皮9例,皮瓣加植皮3例;手部13例,足部3例;仅有动脉裸露3例,仅有静脉裸露9例,动、静脉均裸露4例。裸露动脉外径0.8-2.3 mm,平均1.0 mm,裸露静脉外径0.8~2.5 mm,平均1.2 mm。软组织缺损面积1.0 cmx 1.5 cm^2.6 cmx6.0 cm,应用皮片面积1.0 cmx1.5 cm^2.6 cmx6.0 cm。植皮后不打包加压,供区直接缝合。术后随访观察疗效。结果14例植皮成活,1例部分成活,经制动和换药后愈合,1例植皮坏死。随访时间6~24个月,平均14.4个月。末次随访经CDU、HHD,CTA等手段检测显示15例吻合血管通畅,1例栓塞。皮片无色素沉着,质地柔软、耐磨,两点辨别觉7~10 mm。可触及皮片下吻合动脉搏动。供区仅留线形瘢痕。结论在血管裸露小创面采用全厚皮片植皮手术简单,成活率高,且不影响吻合血管的通畅,疗效确切,有较好的临床应用价值。Objective To report the clinical effect of skin grafting in small wounds with exposed vascular anastomosis.Methods From January,2011 to May,2018,16 small wounds with anastomotic vascular exposure were treated by full-thickness skin grafting.Of which,4 performed after replantation,9 after reconstruction and 3 after flap transplantation.Thirteen wounds were on hand and 3 in foot.After anastomosing the vessels,3 arterial anastomoses,9 venous anastomoses and 4 arterial--and--venous anastomoses were left exposure in wounds.Sizes of artery exposed in wound were 0.8 to 2.3 mm with an average of 1.0 mm.Sizes of vein exposed in wound were 0.8 to 2.5 mm with an average of 1.2 mm.The areas of soft tissue defect were 1.0 cmx1.5 cm to 2.6 cmx6.0 cm,and the areas of grafted skins were 1.0 cmx1.5 cm to 2.6 cmx6.0 cm.Grafted skin were covered without package nor pressurization.Donor areas were directly sutured.Postoperative follow-up was conducted to observe the postoperative ffect.Results Fourteen grafted skin completely survived,one partially suvived and healed after immobilization of the limb and change of dressing,and one developed necrosis.All patients were followed-up for 6-24 months(mean 14.4 months).CDU,HHD or CTA were used at the final follow-up.Vascular anastomoses were patency in 15 patients,and 1 patient had embolism developed.No pigmentation was found on the grafted skin.All grafted skin was soft and wearable with two point discrimination at 7-10 mm.The pulse of anastomotie artery could be felt on the grafted skins.Only linear scars were left in the donor sites.Conclusion The operation of full-thickness skin grafting in small wounds with exposed vascular anastomosis was easy to perform and with high survival rate.The ffect of operation is satisfactory.The exposure of anastomosed vessels does not affect the patency of anastomotic vessels,and has considerable clinical values.

关 键 词：全厚皮片 植皮 血管裸露 创面 修复 

分 类 号：R65[医药卫生—外科学]