全厚皮片回植治疗四肢累及关节大面积皮肤撕脱伤  

Replantation of full-thickness skin graft for treatment of large area skin avulsion injury of extremities involving joints

作　　者：吴卫宾 杜云峰 王红星 张番 WU Wei-bin;DU Yun-feng;WANG Hong-xing;ZHANG Fan(SectionⅡ,Dept of Orthopaedics,the Central Hospital of Jiaozuo Coal Industry Group Co.,Ltd,Jiaozuo,Henan 454000,China)

机构地区：[1]焦作煤业(集团)有限责任公司中央医院骨二科,河南焦作454000

出　　处：《临床骨科杂志》2024年第2期209-213,共5页Journal of Clinical Orthopaedics

摘　　要：目的探讨全厚皮片回植治疗四肢累及关节大面积皮肤撕脱伤的疗效。方法将15例四肢累及关节大面积皮肤撕脱伤患者采用全厚皮片回植治疗。记录回植皮片成活情况。采用温哥华瘢痕量表(VSS)评分评价瘢痕外观情况,采用Highet评价系统评价感觉神经功能恢复情况。根据受累关节不同,分别采用膝关节HSS评分、AOFAS踝-后足评分、肘关节改良Cassebaum评分、腕关节Cooney评分评价关节功能。结果患者均获得随访,时间1~5年。①术后1个月回植皮片成活情况:优14例,可1例。②术后1年VSS评分评价瘢痕外观:满意11例,尚可4例。③术后1年Highet评价系统评价感觉神经功能:S4级5例,S3级9例,S2级1例。④术后1年,9例累及膝关节者HSS评分为优2例、良5例、可1例、差1例;2例累及踝关节者中1例AOFAS踝-后足评分为优,另1例截肢;5例累及肘关节者改良Cassebaum评分为优1例、良3例、可1例;1例累及腕关节者Cooney评分为良。结论全厚皮片回植治疗四肢累及关节大面积皮肤撕脱伤,方法简便易行且皮片成活率高,在外观、感觉恢复方面都能取得满意疗效,待皮片成活后早期配合功能锻炼可促进患者关节功能的恢复。Objective To explore the clinical efficacy of replantation of full-thickness skin graft for treatment of large area skin avulsion injury of extremities involving joints.Methods Fifteen patients with extensive skin avulsion of extremities involving joints were treated with full-thickness skin graft.The survival of replanted skin graft was recorded.The scar appearance was assessed with the Vancouver Scar Scale(VSS),and neurosensory function recovery were evaluated by Highet evaluation system.According to the different joints involved,the joint function was evaluated by knee joint HSS score,AOFAS ankle-hindfoot score,elbow modified Cassebaum score and wrist Cooney score.Results All patients were followed up for 1~5 years.①Survival condition of full-thickness replanted skin graft at 1 month after operation:excellent in 14 cases and fair in 1 case.②The scar appearance was assessed with VSS at 1 year after operation:satisfactory in 11 cases,fair in 4 cases.③At 1 year after operation,the neurosensory function assessed with Highet evaluation system:grade S4 in 5 cases,grade S3 in 9 cases,grade S2 in 1 case.④At postoperative 1 year,HSS scores of 9 cases involving knee joints were excellent in 2 cases,good in 5 cases,fair in 1 case and poor 1 case;in the 2 cases involving ankle joint,1 case was excellent by AOFAS ankle-hindfoot score,and 1 case was amputated;the 5 cases with elbow joint involvement were assessed with the modified Cassebaum score,the results were excellent in 1 case,good in 3,and fair in 1;the 1 case with wrist joint involvement was good by Cooney score.Conclusions Replantation of full-thickness skin graft for the treatment of large area skin avulsion of joints involved in extremities is a simple and easy method with a high survival rate,and satisfactory results can be achieved in appearance and sensation.Early functional exercise after skin graft survival can promote the recovery of joint function.

关 键 词：大面积皮肤撕脱伤 累及关节 全厚皮片 回植 负压封闭吸引技术 

分 类 号：R622.1[医药卫生—整形外科] R658[医药卫生—外科学]