交通事故致下肢大面积皮肤撕脱伤的治疗

Management of extensive avulsed injuries in lower limbs caused by traffic accidents

目的探讨交通事故致下肢大面积皮肤撕脱伤的治疗。方法回顾分析我科收治的30例(34处)交通事故致下肢大面积皮肤撕脱伤的诊治。本组8例截肢;7例皮肤原位缝合;2例中厚皮片游离植皮;10例(12处)去脂全厚皮片开窗回植;1例皮下置管引流,加压包扎;1例穿刺抽吸加压包扎;1例Ⅰ期腓肠神经营养逆行岛状皮瓣转移;1例自体表皮细胞复合同种异体皮肤覆盖创面。同时处理合并损伤。结果平均随访21个月。本组Ⅰ期全部/大部皮片和皮瓣成活共23处,成功率67.6%。4例大面积皮片坏死,Ⅱ期行局部皮瓣或肌皮瓣转移,全厚皮片、皮瓣或肌皮瓣成活后功能良好。结论准确判断伤情和正确选用创面修复方法是确保治疗成功的关键。

Objective To study the management of extensive avulsed injuries in the lower limbs caused by traffic aeeidents. Methods The treatment of 30 patients（ 34 sites） were retrospectively reviewed. Amputation were performed in 8 eases ,sewn-laek in 7 cases, split thickness skin regrafting in 2 cases, defatting fenestrated full thickhess skin regrafting in 10 eases,vacuum drainage and adjuvant compression in I cases,puncture and adjuvant compression in I case,primary faseioeutaneous flap transfer in I case,and autogenic epidermal cells transfer combined with allogencic skin grafting in I ease. Results The average follow-up was 21 months. Twenty-three sites （ 67.6% ） healed well. Four eases eomplicated with extensive skin necrosis were secondarily reconstructed with local skin flaps and myoeutaneous flaps transfer. The function of regrafting full thickness skin,skin flaps and myocutaucous flaps is fine. Conclusion Evaluation of the severity of the injury ,choose the correct repair are the key points for successful treatment.