复合皮移植联合VSD修复碾压伤致肘关节外露  

Elbow Joint Exposure Caused by Crushing Injury Repaired with Composite Skin Grafting Combined with VSD

作　　者：刘晓慧[1] 张鲜英 曹广通[1] 刘毅[1] LIU Xiaohui;ZHANG Xianying;CAO Guangtong;LIU Yi(Department of Burn Plastic and Wound Repair Surgery,Lanzhou University Second Hospital,Lanzhou 730030,Gansu,China)

机构地区：[1]兰州大学第二医院烧伤整形与创面修复外科,甘肃兰州730030

出　　处：《中国美容医学》2024年第1期4-6,共3页Chinese Journal of Aesthetic Medicine

摘　　要：目的:探讨复合皮移植联合负压封闭引流(Vacuum sealing drainage,VSD)在碾压伤伴关节外露创面修复中的临床应用效果及可行性。方法:2020年12月,笔者科室收治1例因左上肢车祸伤致皮肤坏死伴肿胀1 d的患者,入院时查体左上肢肿胀,左前臂、肘部可见约15.0 cm×20.0 cm皮肤坏死,左手感觉功能减退,桡动脉尚可触及,急诊手术探查见肘关节外露、脱位,肱三头肌自肱骨大范围撕脱,尺神经外露、移位,肘关节、尺骨外露范围约3.0 cm×5.0 cm。根据患者病史、临床表现、左上肢X线片及手术探查体征诊断左上肢碾压伤,肘关节外露。应用复合皮移植两步法联合VSD覆盖创面,自体中厚皮片移植修复皮肤缺损。结果:患者左上肢皮肤缺损处愈合良好,术后4个月复查,肘关节屈曲、伸直、旋转功能均恢复良好。结论:对于此例肘关节、骨外露创面,应用复合皮移植后可覆盖骨外露创面,大大降低了手术难度及患者的痛苦,为以后相对小面积骨外露创面的修复提供了新思路。Objective To investigate the clinical effect and feasibility of composite skin grafting combined with vacuum sealing drainage(VSD)in the repair of crush injury with exposed joints.Methods In December 2020,a patient with skin necrosis and swelling of left upper limb caused by traffic accident for 1 day was admitted to the author's department.The patient’s left upper limb was swelling,and her left forearm,elbow which had about 15.0 cm×20.0 cm skin necrosis,left hand feeling was reduced,radial artery could be touched.The patient received emergency surgery,the elbow joint was found exposure and dislocation;The triceps brachii was extensive avulsion from humerus;Ulnar nerve exposed,shift;The elbow,ulna exposed range is about 3.0 cm×5.0 cm.According to the patient's medical history,clinical manifestations,X-ray film of left upper limb and surgery,the diagnosis was left upper limb crushing injury and elbow joint exposure.The skin defect was repaired by two-step composite skin grafting combined with VSD.Results The skin defects of the left upper limb healed well.The reexamination 4 months after surgery showed that the flexion,extension and rotation of the elbow joint was recovered well.Conclusion For this case of elbow joint and exposed bone wound,we can use the composite skin grafting to cover the exposed bone wound,which greatly reduces the difficulty of operation and the pain of patients,and provides a new thought for the repair of relatively small area bone or joint exposure.

关 键 词：复合皮移植 脱细胞真皮基质 碾压伤 肘关节外露 负压封闭引流 

分 类 号：R622[医药卫生—整形外科]