双层人工真皮修复小面积骨外露创面的治疗体会  

Experience in repairing small area of bone exposed wound with double layer artificial dermis

作　　者：杨瑞泽 许玉本 夏雷 毕文超 高磊[1] Yang Ruize;Xu Yuben;Xia Lei(Ward 2,Hand Center,the Afiliated Honghui Hospital of Xi'an Jiaotong University,Xi'an 710054,China)

机构地区：[1]西安交通大学附属红会医院手外中心二病区,710054

出　　处：《美中国际创伤杂志》2023年第2期33-35,64,共4页U.S.Chinese International Journal of Traumatology

摘　　要：目的:探讨双层人工真皮植皮修复小面积骨外露创面的优势与不足,为临床治疗骨外露创面提供更多可选的手术方式。方法:回顾分析我院自2019年6月至2022年6月的手足开放伤并小面积组织缺损骨外露病例,所选病例均为开放伤清创后新鲜创面,创面组织缺损,组织及骨质外露,骨外露面积小于直径2cm。共计81例,其中男48例,女33例;年龄4-76岁,平均32岁。所有患者经创面处理新鲜后,检查外露骨质活性,彻底清理失活骨质,尽量多的保留带活性的骨膜组织,无骨膜的皮质骨予表面行密集钻孔,松质骨刮至新鲜渗血,创面经处理后,将人工真皮剪至合适大小贴敷于创面,缝合固定于皮肤缺损处,松止血带观察人工真皮下渗血形成薄层胶质覆盖骨质,适当打包加压,经5-7d后,拆除加压包,伤口常规换药,术后2-3w待硅胶层自动分离,二期揭除硅胶层,于胶冻状人工真皮上游离植皮,凡士林纱布打包加压,7d后拆除加压包,观察植皮成活情况。术后定期伤口换药,分别于术后7d、15d、30d、60d观察创面愈合情况。根据创面愈合情况评估治疗效果。结果:所纳入治疗患者术后均获6-24月随访,术后75例创面一期愈合,3例局部骨外露创面二期转移皮瓣或螺旋桨皮瓣覆盖后创面愈合,2例术后创面骨外露采取游离皮瓣覆盖创面,1例植皮后皮片坏死,再行游离植皮手术后创面愈合。术后60d综合评价有效率92.6%。结论:手足小面积骨外露创面严重影响外观及功能,植皮仅能覆盖软组织创面,骨外露问题很难解决,传统的皮瓣手术虽然创面覆盖良好,但外形臃肿,手术风险大,供区损伤严重,术后护理繁杂,因此小面积骨外露创面往往陷入植皮与皮瓣两难的境遇,双层人工真皮植皮技术,为此类创面提供了新的治疗思路,既可以良好覆盖骨外露创面,又能获得良好外观、减少供区损伤,值得进一步探索并在临床推广应用。Objective:To discuss the advantages and disadvantages of double-layer artificial dermal skin grafting to repair small area of bone exposed wounds,and provide more alternative surgical methods for clinical treatment of bone exposed wounds.Methods:Retrospective analysis of the cases of hand and foot injuries with small tssue defects and bone exposure in our hospital from June 2019 to June 2022.The selected cases are fresh wounds after open wound debridement,with tissue defects on the wound surface,and tissue and bone exposure.The exposed area of bone is less than 2cm in diameter.A total of 81 cases,including 48 males and 33 females;aged 14 to 76 years old,with an average of 32 years old.After all patients are freshly treated with wounds,check the activity of exposed bone,thoroughly clean the inactivated bone,and retain as much active periosteal tissue as possible.The cortical bone without periosteum is intensively drilled on the surface,and the cancellous bone is scraped until fresh infiltration.After the blood and the wound are treated,cut the artificial dermis to a suitable size and apply it to the wound,suture and fix it on the skin defect.Loosen the tourniquet to observe the blood oozing under the artificial dermis to form a thin layer of glue covering the bone.Pack and press properly.After 5-7 days,remove the pressure pack and change the wound dressing routinely.2-3 weeks after the operation,the silicone layer will be separated automatically.The silicone layer will be removed in the second stage,and the skin graft will be freed on the jelly-like artificial dermis.After days,the pressure pack was removed and the skin graft survival was observed.Wound dressing was changed regularly after operation,and wound healing was observed at 7d,15d,30d,and 60d postoperatively.Evaluate the treatment effect according to the wound healing.Results:All the included treatment patients were fllowed up for 6-24 months postoperatively.After the operation,75 cases of wounds healed at first stage,3 cases of local bone exposed wounds

关 键 词：人工真皮 骨外露 创面修复 

分 类 号：R47[医药卫生—护理学]