一期原位回植联合VSD技术治疗下肢完全皮肤脱套伤的临床疗效分析  

Clinical analysis of primary orthotopic replantation combined with VSD technique in the treatment ofcomplete skin degloving injury of lower extremities

作　　者：吴建科 黄永禄[1] 郭静[2] 张汉霖 丁一 马国续 贾怀绪 张梓炀 张博闻 赵飞[1] WU Jianke;HUANG Yonglu;GUO Jing;ZHANG Hanlin;DING Yi;MA Guoxu;JIA Huaixu;ZHANG Ziyang;ZHANG Bowen;ZHAO Fei(Department of Hand,Foot and Reconstructive Microsurgery,People′s Hospital of Ningxia Hui Autonomous Region,Yinchuan 750002,China;Department of Pediatric Neurorehabili tation,People′s Hospital of Ningxia Hui Automous Region,Yinchuan 750002,China)

机构地区：[1]宁夏回族自治区人民医院手足和重建显微外科,宁夏银川750002 [2]宁夏回族自治区人民医院儿童神经康复科,宁夏银川750002

出　　处：《宁夏医学杂志》2023年第10期883-886,共4页Ningxia Medical Journal

基　　金：宁夏重点研发计划项目(2019BEG3044);宁夏青年科技人才托举工程资助项目(202078);宁夏回族自治区科技惠民专项(2023CMG03014);2023年度医院科技创新人才培养项目(2023-2)。

摘　　要：目的 分析一期原位回植联合负压封闭引流技术(VSD)治疗下肢完全皮肤脱套伤的疗效,为临床四肢大面积皮肤脱套伤的治疗提供借鉴。方法 收集下肢完全脱套伤(占体表面积20%以上)患者25例,研究组14例行一期剥脱皮肤原位回植联合VSD治疗,对照组11例一期行彻底清创,VSD敷料覆盖,二期取对侧大腿皮植皮,观察对比植皮成活率、住院时间及并发症发生率等指标,评价远期患者功能恢复状况。结果 研究组14例患者脱套皮肤回植成活率为(90.65±2.25)%,对照组为(80.86±3.69)%,2组比较差异有统计学意义(P<0.05);研究组成活效果优为11例,良为2例,差为1例,对照组成活优为5例,良为3例,差为3例;研究组术后并发症发生率为8%,对照组为28%;2组患者的平均住院时间比较差异有统计学意义(P<0.05)。结论 下肢皮肤大面积脱套伤行一期原位回植联合VSD治疗,回植皮肤成活率高,皮肤成活效果及肢体功能恢复好。Objective To observe the efficacy of primary orthotopic replantation combined with vacuum sealing drainage(VSD)in the treatment of complete skin degloving injury of the lower limbs,with the aim of providing reference for the clinical treatment of large-scale skin degloving injury of the limbs.Method 25 patients with complete degloving injury of the lower limbs(accounting for more than 20%of the body surface area)were collected.The study group consisted of 14 patients who underwent primary skin exfoliation and in situ replantation combined with VSD treatment,while the control group consisted of 11 patients who underwent thorough debridement and VSD dressing coverage in the first stage.The second stage underwent skin grafting on the opposite thigh.The survival rate,hospitalization time and incidence of complications were observed and compared to evaluate the long-term functional recovery status of patients.Results The survival rate of 14 patients with degloving skin replantation in the study group(90.65±2.25)%was higher than that in the control group(80.86±3.69)%.The difference between the two groups was statistically significant(P<0.05).There were 11 cases with excellent results,2 cases with good results and 1 case with poor results in the study group.There were 5 cases with excellent results,3 cases with good results,and 3 cases with poor results in the control group.The incidence of postoperative complications in the study group(8%)was lower than that in the control group(28%).There was a statistically significant difference in the average hospitalization time between the two groups of patients(P<0.05)..Conclusion The combination of one-stage in situ replantation and VSD treatment for large-scale degloving injury of the lower limb skin has a high survival rate,good skin survival effect and limb function recovery.

关 键 词：皮肤脱套伤 原位回植 负压封闭引流 远红外线治疗 

分 类 号：R658.2[医药卫生—外科学]