水刀清创系统加反植皮术负压封闭治疗儿童重度污染性皮肤撕脱伤  

Treatment of severely contaminated skin avulsion injury in children with hydrosurgery system,vacuum-assisted closure and skin graft

作　　者：章磊 季易[1] 沈卫民[1] Zhang Lei;Ji Yi;Shen Weimin(Department of Burns&Plastic Surgery,Affiliated Children'S Hospital,Nanjing Medical University,Nanjing 210008,China)

机构地区：[1]南京医科大学附属儿童医院烧伤整形科,南京210008

出　　处：《中华小儿外科杂志》2023年第3期248-251,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨水刀清创系统加反植皮术、封闭负压引流技术(vacuum assisted closure,VAC)在污染严重的皮肤撕脱伤的急诊创面处理中的治疗效果。方法收集2018年7月至2020年12月南京医科大学附属儿童医院收治的5例车祸伤患儿临床资料,其中男3例,女2例,年龄6~12岁。患儿创面污染严重伴皮肤撕脱及缺损,伴或不伴有肌肉、骨骼损伤。纠正休克稳定生命体征,生命体征平稳后行急诊手术,利用水刀系统清创进行清创联合反植皮和负压封闭治疗。结果5例患儿术后反移植皮片部分存活,存活面积为原撕脱面积的50%~70%。VAC治疗后,术后创面细菌种植率低,均未发生脓毒血症,5例患儿均行两次邮票植皮后创面愈合。治疗时间为34~62 d,平均为46.2 d。结论水刀系统的应用可以降低污染性创面细菌种植,为皮片移植创造相对较好的基地,促进反植皮片存活,VAC治疗为进一步控制感染、生长肉芽提供了很好的基础,为二期邮票植皮准备了创面,改善预后。Objective To explore the therapeutic efficacy of hydrosurgery system plus reattachment of injured skin and vacuum-assisted closure(VAC)for emergency wound debridement of seriously polluted skin avulsion injury.Methods From July 2018 to December 2020,5 children of automobile accident injuries were treated.There were 3 boys and 2 girls with an age range of(6-12)years.There were serious wound pollution,skin avulsion and defect with or without muscle and bone injury.After correcting shock and stabilizing vital signs,emergency surgery was performed.Hydrosurgery system was employed for debridement and reattachment of injured skin with VAC.Results Skin grafts survived partially and survival area was 50-70% of original avulsion area.After VAC,postoperative wound bacterial implantation rate was low.Wound healed without sepsis after two rounds of stamp skin grafting.The mean treatment period was 46.2(34-62)days.Conclusions Application of hydrosurgery system may minimize bacterial planting,create a relatively favorable environment for skin graft and promote the survival of skin grafts.And VAC provides an excellent condition for further infection control and granulation growth.It is conducive to second-stage stamp skin grafting with a better prognosis.

关 键 词：皮肤移植 清创术 撕脱伤 植皮术 

分 类 号：R726.2[医药卫生—儿科]