皮肤牵张术保留肢体残端关节的临床研究

Joint reservation of amputated extremity stump using skin stretching technique

目的探讨皮肤牵张术在保留严重创伤肢体残端关节中的应用。方法对关节下残端彻底清创后,安置皮肤牵张器,保持张力在1～3 kg。估计伤口边缘可以拉拢时即可缝合伤口。结果本组6例经牵引后顺利缝合皮肤,牵张时间平均7 d(3～21 d),1例跗横关节下截肢者皮肤延展性较差,牵张效果较差。3例发生皮缘干瘪发黑,经修剪后均不影响伤口缝合。结论皮肤牵张技术利用皮肤的黏弹性,以简单的方式解决了关节下截肢伤口的皮肤缺损问题,降低了与复杂修复重建治疗相关的并发症。

Objective To observe the coverage effects of below-joint stump wound using skin stretching technique.Methods After debridement,a skin-stretching device was applied.Traction about 1-3 kilogram was applied through loops of steel wire passed through the dermis.Once approximation of wound margins was accomplished,the wound was sutured.Results In 6 cases of complete wound closure was obtained,the average period of stretching was 7（3-21）d.Because the bad ductility of forefoot,complete closure was not obtained after traction for 21 d in one case.In 3 cases,there was significant nigrescence occurred in skin margins,without influence on the suture.Conclusion Based on the viscoelastic properties of skin,the simply skin-stretching device provides healthy,durable and sensate skin for stump coverage,thereby avoid the use of split skin grafts or free flaps and their resultant additional morbidity.