牵力可调式皮肤牵张器联合负压封闭引流治疗足踝部软组织缺损  

The traction-adjustable skin stretcher combined with vacuum sealing drainage for treatment of soft tissue defect of ankle and foot

作　　者：杨俊[1] 赵敏[1] 周江军[1] YANG Jun;ZHAO Min;ZHOU Jiang-jun(Dept of Orthopaedics,the 908th Hospital of Joint Logistic Support Force of CPLA,Yingtan,Jiangxi 335000,China)

机构地区：[1]中国人民解放军联勤保障部队第九〇八医院骨科,江西鹰潭335000

出　　处：《临床骨科杂志》2021年第6期825-828,共4页Journal of Clinical Orthopaedics

基　　金：江西省科技厅科技支撑计划(编号:20132BBG70092);全军医学科技青年培育项目(编号:13QNP049);“十二五”全军后勤科研计划重点项目(编号:BNJ13J003)。

摘　　要：目的探讨牵力可调式皮肤牵张器联合负压封闭引流(VSD)治疗足踝部软组织缺损的疗效。方法采用牵力可调式皮肤牵张器联合VSD治疗16例足踝部软组织缺损,缺损面积3 cm×2 cm~8 cm×4 cm。所有患者一期行清创VSD,9例无内固定物患者行牵力可调式皮肤牵张术;7例内固定外露患者均为术后2周内出现皮肤坏死、伤口裂开,清创后无法直接缝合,连续2次细菌培养阴性、伤口无渗出液后,二期行牵力可调式皮肤牵张术。结果患者均获得随访,时间1~3年。伤口均愈合,时间2~5(3.2±1.3)周。其中1例患者皮肤牵张过程中出现创面皮缘坏死、针道红肿、克氏针切割穿出,再次行VSD,红肿消退、感染控制后行牵力可调式皮肤牵张术,创面愈合。末次随访时,外观不臃肿,皮肤有感觉、耐磨,患者对皮肤牵张疗效均满意。结论牵力可调式皮肤牵张器联合VSD治疗足踝部软组织缺损,安全有效,简便易操作,避免了供区损伤,伤口愈合后外观不臃肿、耐磨、有感觉。Objective To investigate the effect of traction-adjustable skin stretcher combined with vacuum sealing drainage(VSD)in the treatment of soft tissue defect of foot and ankle.Methods Sixteen cases who suffered from soft tissue defects of feet and ankles were treated with traction-adjustable skin stretchers combined with VSD.The defect area was 3 cm×2 cm~8 cm×4 cm.All patients underwent debridement VSD in one-stage,of which 9 patients without internal fixation underwent traction-adjustable skin stretching;7 cases with internal fixation exposure were caused by skin necrosis and wound dehiscing within 2 weeks after operation,and the wound could not be directly sutured after debridement,two consecutive bacterial cultures were negative,and the wound had no exudate,and the traction-stretchable skin stretching was performed in the two-stage.Results All patients were followed up for 1~3 years.All wounds healed within 2~5(3.2±1.3)weeks.In the process of skin stretching,1 patient had necrosis of the wound edge,redness and swelling of the needle track,and Kirschner wire cutting and puncture.VSD surgery was performed again.When redness and swelling was disappeared and infection was controled,traction-adjustable skin stretching was performed,and wound got healing.At the last follow-up,the appearance was not bloated,the skin was feeling and wear-resistant,all patients were satisfied with the effect of skin stretching.Conclusions In the treatment of soft tissue defect of foot and ankle,traction-adjustable skin stretcher combined with VSD are safe and effective,easy operation,and which avoids the injury of donor area.After wound healing,the appearance is not swollen,wear-resistant and sensible.

关 键 词：皮肤牵张 负压封闭引流 足踝部软组织缺损 

分 类 号：R658.3[医药卫生—外科学] R622[医药卫生—临床医学]