皮肤牵张闭合器在封闭截肢残端大型皮肤缺损中的应用  

Application of skin retractor closure device in sealing large skin defect of amputation stump

作　　者：李林 赵永健 李红卫 LI Lin;ZHAO Yongjian;LI Hongwei(Department of Burn and Plastic Surgery,Affiliated Hospital of Nankai University/Tianjin Municipal Fourth Hospital,Tianjin 300222,China)

机构地区：[1]南开大学附属医院/天津市第四医院烧伤整形科,天津300222

出　　处：《重庆医学》2021年第23期4087-4090,共4页Chongqing medicine

摘　　要：目的探讨使用皮肤牵张闭合器封闭截肢残端的大型皮肤缺损创面的可行性及临床效果。方法选择该院在2019年5月至2020年5月收治的7例残端大面积皮肤坏死或者大面积慢性创面的患者,给予清创后使用皮肤牵张闭合器进行局部拉拢,然后给予局部缝合封闭残端。结果7例患者残端创面均通过放置牵张闭合器牵拉后进行拉拢缝合封闭,其中5例一次手术牵张闭合创面,1例因收紧牵张闭合器封闭创面过程中创缘血运不良,1例因基底情况不良存在严重感染,第一次手术给予放置创面持续性封闭式负压引流(VSD)联合牵张闭合器,术后间断收紧牵张闭合器,3 d后取出VSD牵拉闭合创面。7例患者残端均恢复良好,术后3个月复查,患者满意度100%,局部耐磨性良好,无反复破溃情况。结论应用皮肤牵张闭合器封闭截肢残端大型皮肤缺损,相对于皮肤(皮瓣)移植,继发损伤更小,且可以明显改善残端耐磨性及后期整体适应性,更利于患者的康复。Objective To investigate the feasibility and clinical effect of using the skin retractor closure device to close large skin defect wound of amputation stump.Methods Seven patients with large area of skin necrosis or large area of chronic wounds in amputation stump in this hospital from May 2019 to may 2020 were selected.After debridement,the skin retractor closure device was used for local closure,and then the local suture was used to seal the stump.Results The stump wounds of 7 cases were closed by pulling and suturing after placing the traction closure device.Among them,5 cases were closed by once traction,1 case had poor blood supply at the wound edge due to tightening the traction closure device,and 1 case had severe infection due to poor basal condition.The wound surface persistent vacuum sealing drainage(VSD)combined with the traction closure device was placed in the first operation,and the traction closure device was tightened intermittently after operation,VSD on postoperative 3 d was removed and the wound was closed by traction.All the stumps of 7 cases recovered well.In the re-examination after postoperative 3 months,the patient′s satisfaction was 100%,the local wear resistance was good without the repeated ulceration.Conclusion Compared with the skin(flap)transplantation,the application of skin retractor closure device in the closure of large skin defects of amputated stump has less secondary injury,and can significantly improve the wear resistance of the stump and the overall adaptability in the later stage,which is more conducive to rehabilitation of the patients.

关 键 词：截肢术后 皮肤缺损 皮肤牵张 皮肤牵张闭合器 修复 

分 类 号：R622[医药卫生—整形外科]