四肢大面积皮肤撕脱伤早期处理探讨

Early Management of Extensive Skin Avulsion of the Extremities

四肢大面积皮肤撕脱伤，是由于其皮肤可能未完全离体，或无伤口却有潜行剥离，早期皮肤的颜色接近正常，常漏诊或处理不当，正确的早期处理，对抢救生命，尽早修复创面，恢复肢体功能，缩短治疗时间关系重大。作者对20年中收治的45例大面积皮肤撕脱伤处理作了分析。早期处理，时间愈早愈好；彻底清创是保证创面Ⅰ期愈合的关键；直接缝合只适用于小面积片状撕脱；撕脱皮肤回植，可节省皮源；皮瓣修复适用撕脱层次深，深层组织裸露者；以及手、足、小腿下段特殊需求者。足底、踝、跟腱等处的皮肤撕脱，皮片移植甚难愈合，即使创面修复，亦不能承受重力，要彻底解决皮瓣的耐磨、耐重力问题，仍需作有神经营养、感觉功能的带感觉神经皮瓣移植。

The avulsed skin flap may be still connected with the body or a large hidden dissecting cavity may be present without skin wound. Both of them make the prompt diagnosis of an extensive skin avulsive injury of the extremities very difficult, especlally in the early stage when the color of the skin appears nearly normal. However, an early diagnosis with correct wound treatment is mandatory in shortening the course of treatment, restoring the function of the extremities and even life saving.Based on their experience on treating 45 cases of extensive skin avulsion of the extremiies during the past 20 years, the authors suggest the following key points in the success of treatment:(1) The earlier the treatment, the better the results; (2)Meticulous debridemet is important for the primary healing of the wound; (3)Direct suture of the avulsed skin can only be performed in case of small wound; (4)Regrafting with treated avuIsed skin may economized the dornor skin; (5)Repair with a thick skin flap is simultaneous loss of deeper tissue.Avulsion skin wounds with hand, foot or lower part of the leg are slow to heal. Autotransplantation with s sensory skin flap consisting of trophic nerve supply is always necessary.