封闭负压引流联合脱细胞真皮和自体刃厚皮移植治疗足踝部创面30例  

Application of VSD combined with acellular dermis and autologous split thickness-skin grafting in repairing the foot and ankle wounds in 30 cases

作　　者：吴德金 赵遵江 张保德[1] 章荣涛[1] 王修坤[1] 刘勇[1] Wu Dejin;Zhao Zunjiang;Zhang Baode;Zhang Rongtao;Wang Xiukun;Liu Yong(Burn and Plastic Surgery Department of Lu’an People’s Hospital of Anhui,Lu’an,Anhui 237000,China;Burn and Plastic Surgery Department of the first affiliated Hospital of Wannan Medical College,Wuhu,Anhui 241000,China)

机构地区：[1]安徽省六安市人民医院烧伤整形外科,安徽六安237000 [2]安徽省皖南医学院弋矶山医院烧伤整形科,安徽芜湖241000

出　　处：《感染．炎症．修复》2022年第3期145-147,F0003,共4页Infection Inflammation Repair

基　　金：安徽省“十三五”医疗卫生重点专科建设科研经费资助项目(2017LASZDXKZXJF003)。

摘　　要：目的:观察封闭负压引流(VSD)联合脱细胞真皮及自体刃厚皮移植治疗足踝部创面的应用效果。方法:安徽省六安市人民医院烧伤整形外科2019年1月—2021年3月收治的足踝部创面患者共30例,先经清创、VSD治疗,于创面生长良好后行脱细胞真皮及自体刃厚皮移植修复创面,观察术后患者创面愈合情况,并随访术后2周及1、3、6个月的修复效果。结果:植皮术后1周换药可见,28例患者植皮后皮片均完全存活,2例局部见小面积植皮区未愈合,经约7d换药后均愈合。术后1、3、6个月随访,所有患者原手术区均未再次破溃,踝关节活动良好,术后半年有3例糖尿病患者因足趾出现破溃而可见轻度跛行。结论:VSD联合脱细胞真皮及自体刃厚皮移植修复足踝部创面的方法,不仅可有效改善单纯植皮手术带来的不耐磨、瘢痕挛缩问题,同时也可改善皮瓣移植带来的皮瓣臃肿等问题,对于不伴有大面积骨外露和肌腱外露足踝部创面的修复有良好的治疗效果。Objective:To observe the effect of the vacuum sealing drainage(VSD)combined with acellular dermis and autologous split-thickness skin grafting in the treatment of foot and ankle wounds.Methods:30 patients with foot and ankle wounds were admitted to the Burn and Plastic Surgery Department of the Lu’an People’s Hospital of Anhui from Jan.2019 to Mar.2021.They were treated with VSD after debridement and repaired with acellular dermis and autologous split-thickness skin grafting after good growth.The healing time of the wounds after surgery was observed,and the status of the wounds were followed up at 2 weeks,1 month,3 months and 6 months after operation.Results:Dressing change 1 week after surgery,28 patients were completely healed after skin grafting,and the other 2 patients were not healed locally with small skin graft area.Finally,they all healed completely after dressing change for about 7 days.In the 1,3,and 6 months follow-up,all patients did not break again in the original operation area,and the ankle joint activity was good.Six months after surgery,3 patients with diabetes were slight claudication due to the ulceration toe.Conclusions:The foot and ankle wounds repair method of VSD combined with acellular dermis and autologous split-thickness skin grafting can not only effectively improve the problems of non abrasion resistance and scar contracture that caused by simple skin grafting,but also improve the problems of skin flap bloat caused by skin flap grafting,which has a good therapeutic effect on the repair of the foot and ankle wounds without large area of bone exposure and tendon.

关 键 词：封闭负压引流 脱细胞真皮 自体刃厚皮 足踝部创面 

分 类 号：R62[医药卫生—整形外科] R622.1[医药卫生—外科学] R644[医药卫生—临床医学]