局部组织瓣双重覆盖法在内置物外露创面中的应用  

Application of local tissue flap double covering method in the wound of the exposed implants

作　　者：李亚玲 王雷[1] 李晴 张舒曼 周粤闽 LI Ya-ling;WANG Lei;LI Qing;ZHANG Shu-man;ZHOU Yue-min(Plastic and Reconstructive Surgery,Huaihe Hospital,Henan University,Henan Province,475000,China)

机构地区：[1]河南大学淮河医院整形修复外科,河南开封475000

出　　处：《中国医疗美容》2023年第9期16-19,共4页China Medical Cosmetology

摘　　要：目的 探讨采用局部组织瓣双重覆盖法修复内置物外露创面的有效性。方法 回顾性分析自2018年1月至2021年08月因创面内置物外露在我科行手术治疗患者的病例资料,其中漏斗胸NUSS术后切口不愈致双侧胸壁钢板外漏2例,单侧钢板外露2例,共6处创面,因脑积水行脑室腹腔分流术后储液囊外露1例,脑室分流管外露1例,颅骨修复术后钛网外露3例,创面大小1.5 c m×1.2 c m~5.0 c m×4.0 c m,所有患者进行全身治疗,创面经清创换药处理或直接缝合后未愈合者采用手术治疗,术中充分分离周围肌肉组织瓣和(或)去表皮组织瓣交叉双重覆盖于外露内置物上方,皮肤组织进行减张缝合,术后给予负压吸引或抗感染等对症处理;结果 11例内置物全部成功保留,创面愈合良好,术后随访1~4年,内置物无再次外露。结论 在需要保留内置物且创面周围组织无良好覆盖的面积较小的外露创面,局部组织瓣双重覆盖是内置物外露创面修复的有效方法。Objective To investigate the effectiveness and indications of the double-coverage method of local tissue flaps in repairing the wounds with exposed implants;Method A retrospective analysis of patients who underwent surgical treatment in our department due to exposure of wound implants from January 2018 to August 2021.Among them,there were 2 cases of bilateral chest wall steel plate leakage and 2 cases of unilateral steel plate exposure caused by non healing of the incision after NUSS surgery for pectus excavatum,totaling 6 wounds;Bilateral exposure of steel plates due to hydrocephalus after ventriculoperitoneal shunt surgery,1 case of flfluid storage sac exposure,1 case of ventriculoperitoneal shunt tube exposure,3 cases of titanium mesh exposure after skull repair surgery,wound size 1.5cm×1.2cm~5.0cm×4.0cm;All patients undergo systemic treatment,and those whose wounds have not healed after debridement or direct suturing are treated surgically.During the surgery,the surrounding muscle tissue flflap and/or epidermal tissue flflap are fully separated and crossed to cover the exposed implant.The skin tissue is sutured with reduced tension,and symptomatic treatments such as negative pressure suction or anti infection are given postoperatively;Result All implants were successfully preserved,the implants were not re-exposed during the follow-up for 1.5-4.0 years after surgery.Conclusion Double coverage with local tissue flflap is an effffective method for repairing small exposed wounds that require retention of implants and lack of good coverage of surrounding tissue.

关 键 词：内置物外露 创面 组织瓣 双重覆盖 

分 类 号：R641[医药卫生—外科学]