慢性创面手术治疗方法探讨

Evaluation of Operative Methods for Chronic Wound

目的探讨慢性创面不同手术方法修复的效果。方法1990～2005年对119例患者分别应用中厚皮片移植67次;皮瓣移植36个,肌皮瓣移植19个,肌瓣转移2个,治疗慢性创面124个。所有创面术前均采用负压引流,皮瓣、肌皮瓣术后均采用负压引流。结果52例患者皮片成活率达98%以上(包括1例肌瓣表面植皮),13例患者达95%以上,有2例患者行补充植皮。3例局部皮瓣出现边缘表皮坏死,换药后治愈外,其余皮瓣、肌皮瓣、肌瓣均全部成活,创面一期修复。创面修复后外观满意者106例,基本满意12例,不满意6例(5例均为肌皮瓣转移术的局部臃肿,1例为植皮术后凹陷瘢痕)。结论无骨、肌腱、血管、神经等重要组织外露,局部瘢痕化不太严重,修复部位对耐磨和感觉要求不高、时间较短的慢性创面可以选择中厚皮片移植;对外观需求较高且创面较凹陷者可选用局部皮瓣或肌皮瓣;局部感染明显或需改善血液循环的慢性创面最好选用肌瓣或肌皮瓣修复。密闭负压引流技术对保证手术成功具有十分重要的作用。

Objective To evalute the effect of treating chronic wound with different surgical techniques. Methods From 1990 to 2005, 119 patients were treated with free skin graft, skin flap transfer, myocutaneous flap transfer and pedical muscle graft. V ure（VAC） was used in all the chronic wound before opertion and after skin flap transfer. Results In 67 chronic wound with free skin graft, 52 skin survival rate was 98%, 13 skin survival rate was 95%. 2 skin survival rate was lower in need of skin graft once more. 3 of 36 chronic wound with flap transfer had a little necrosis at the edge of flap,the other flaps survived completely. Conclusion The chronic wound ,which wasn＇t exposure of bone or tendon or nerve or vessels ,which had not very severe scar,which formed in short-time,which didn＇t demand in the aspect of repairing skin felling and friction resistance ability, can be selected using free skin graft. Myocutaneous flap or pedical muscle graft can be used to repair the serious infective chronic wound or blood supply insufficient. VAC was very important for successful operation.