手部脱套伤的分类与个体化治疗

Classification of hand degloving injuries and indiviualized treatment

目的探讨手部皮肤脱套伤的分类与治疗措施。方法按照手部套脱伤损伤范围、深浅度进行分类，针对不同伤情，引入个体化治疗的概念，术中采取由深到浅的方式逐层修复组织，并且有针对性地应用阶梯式修复血管、交替式切口清创、局限性缝合固定、区域性加压包扎及散在性切口引流等创新技术。结果本组共76例，随访时间3—48个月，其中75例经治疗全部成活。皮肤外形美观，耐摩擦能力强，基本恢复了原来的功能。结论对手部脱套伤的分类能使复杂问题简单化，便于对伤情迅速作出判断，从而有针对性地进行个体化治疗。所采用的5项手术技巧，一定程度上解决了手部脱套伤术中的技术难题。个体化治疗为临床手部脱套伤的救治开辟了一条全新的途径。

Objective To evaluate the classification and treatment methods of hand degloving injuries. Methods Individualized treatment was adopted according to area and depth of degloving injuries. The injury was repaired from deep to shallow layer. New techniques such as segment blood vessel repair, alternative debridement, local fixation and suturing, local pressure bandaging and sporadic drainage of incision were applied. Results All 76 patients were followed up for 3-48 months, which showed that 75 patients were cured, with good shapes of the skins and strong rub resistance. Conclusion Classification of hand degloving injuries simplifies diagnosis, as facilitates the individulized treatment. Five new techniques mentioned above may help solve the problems encountered during operation. Individulized treatment explores new ways for the treatment of hand degloving injuries.