打薄回植联合创面负压引流治疗大面积逆行皮肤撕脱伤的临床研究  

Clinical study of thinning and replanting combined with VAC negative pressure drainage in the treatment of large area of retrograde skin avulsion injury

作　　者：李艳军 张锡平 徐红 黄美全 Li Yanjun;Zhang Xiping;Xu Hong;Huang Meiquan(Department of Tramatic Orthopedics,Zhuzhou Central Hospital,Zhuzhou 412007,China)

机构地区：[1]湖南株洲市中心医院创伤骨科,412007

出　　处：《中国医师杂志》2021年第10期1542-1545,共4页Journal of Chinese Physician

摘　　要：目的研究打薄回植联合创面负压引流(VAC)治疗大面积逆行皮肤撕脱伤的临床效果。方法选取2017年4月至2019年4月株洲市中心医院创伤骨科收治的42例大面积逆行皮肤撕脱伤患者进入本研究,均行自体逆行撕脱皮肤打薄回植手术并于术后采用创面持续负压引流。观察患者创面成活率、成活面积、创面感染情况、回植皮肤性能及关节活动度情况。结果42例患者均进行随访,随访时间8~50(23.56±3.56)个月,术后有35例患者1期植皮区成活,皮瓣皮肤存活且创面无明显皮肤缺损,积极换药后其创面已愈合良好,不需进行二次手术;7例患者因皮肤大面积缺损术后一期创面出现小面积坏死,经2期手术移植、加强换药后创面愈合良好。26例患者美国特种外科医院(HSS)膝关节评分达80~95(87.96±3.21)分,22例患者踝与后足功能评分(AOFAS)达80~96(88.79±3.41)分。无感染、截肢情况。所有患者回植皮肤感觉、弹性、耐压性、耐磨性及颜色等各方面良好,关节活动性良好,未见明显活动受限。结论打薄回植联合VAC治疗大面积逆行皮肤撕脱伤患者能够明显促进创面与皮片贴敷,有利于将引流液引流出体外,降低创面感染率,提高植皮成活率,改善关节功能。Objective To study the clinical effect of thin replantation combined with vacuum assisted closure(VAC)in the treatment of large area retrograde skin avulsion injury.Methods A total of 42 patients with large scale retrograde skin avulsion injury admitted to the trauma center of Zhuzhou Central Hospital from April 2017 to April 2019 were enrolled in this study,and were treated with VAC continuous negative pressure drainage after operation.The wound survival rate,wound survival area,wound infection,replantation skin performance and joint mobility were observed.Results All of the 42 patients were followed up for 8-50(23.56±3.56)months.35 patients survived the stage 1 skin grafting,the skin flap survived,and the wound had no obvious skin defect.After active dressing change,the wound healed well,and no second operation was needed.Small area necrosis occurred in the first stage wound of 7 patients due to large skin defect,and the wound healed well after the second stage surgical transplantation and enhanced dressing change.The Hospital for Special Surgery(HSS)score of 26 patients was 80-95(87.96±3.21),and the American Orthopaedic Foot and Ankle Society(AOFAS)score of 22 patients was 80-96(88.79±3.41).All patients had good skin sensation,elasticity,pressure resistance,wear resistance and color,and joint mobility was good without obvious limitation of movement.Conclusions Thinning replantation combined with VAC negative pressure drainage in the treatment of large area retrograde skin avulsion injury can significantly promote the application of wound surface and skin graft,which is conducive to drain the drainage fluid out of the body,reduce the wound infection rate,improve the survival rate of skin grafting and improve joint function.

关 键 词：皮肤移植 移植 自体 负压伤口疗法 皮肤撕脱伤 关节功能 

分 类 号：R641[医药卫生—外科学]