臀会阴及下肢大面积皮肤软组织撕脱伤的治疗

The Treatment of the Extensive Skin and Soft Tissue Avulsion Injury in Buttocks,Perineal Area and Lower Limbs

目的:回顾性分析臀会阴及下肢大面积皮肤软组织撕脱伤的治疗体会。方法:2005年1月至2007年6月,对8例臀会阴及下肢大面积皮肤软组织撕脱伤患者进行综合治疗。男4例,女4例,年龄4～48岁,平均26岁,病程1天～1月,平均2周。皮肤撕脱达体表总面积8%～20%。致伤原因:车祸伤7例,高坠伤1例。其中7例成人均上翻身床治疗,1例小孩床上自行翻身,6例由于创面距肛门较近或脊髓损伤不能控制大便而行结肠造瘘,通过造瘘口排便,创面愈合3月后行造瘘还纳术。所有患者均通过积极创面处理、肉芽新鲜后行刃厚植皮术而痊愈。结果:8例患者经过我们的综合治疗后伤口均愈合,随访6月后皮肤愈合良好。6例行结肠造瘘的患者中3例因骨盆骨折稳定于出院后3月左右行结肠造瘘还纳术,恢复肛门排便,3例伴有脊髓损伤患者而不能自行控制排便的患者在随访期间未行结肠造瘘还纳术。结论:臀会阴及下肢大面积皮肤软组织撕脱伤患者通过上翻身床,必要时行结肠造瘘,积极的创面处理及对症支持治疗能取得较好效果。

Objective： Retrospectively analyze the treatment experiences of the extensive skin and soft tissue avulsion injury in lower limbs, buttocks and perineal area. Methods： From January 2005 to June 2007, comprehensive treatments were applied to eight cases with skin and soft tissue avulsion injury in lower limbs, buttocks and perineal area. Among them, 4 males and 4 females, aged 4 - 48 years old, an average of 26-year-old, disease course was 1 day to 1 month, an average of 2 weeks, skin avulsion area was 8% - 20% total body surface area （TBSA）, 7 cases for car accident and 1 case for high falling injury. Of which 7 cases were adults using turn-over bed, 1 case was child turning over in bed by himself. Six cases perform colostomy because of the close-wounds to the anus or uncontrolled defecation due to spinal cord injury, which were returned 3 month later after wound healing. All patients had wound healing through active wound treatment and following thin-partial-thickness graft on fresh granulation. Results： Through our comprehensive treatments, 8 patients all achieved wounds healing, and maintained well during a following-up of 3 to 6 month. Three among 6 cases who performed colostomy discharged for a stable pelvic fracture and returned the artificial anus 3 monthes later with defecation from anus; the others with spinal cord injury who were unable to control the bowel did not return in the follow-up period. Conclusion： Patients with extensive skin and soft tissue avulsion injury in lower limbs, buttocks and perineal can achieve better results by carrying on the turn-over bed, colostomy if necessary, active wound treatment and symptomatic supportive treatment.