四肢大面积皮肤撕脱伤的治疗(附12例报告)

Therapeutic effect of large area avulsion skin injuries of limbs (12 case reports attached)

目的总结反鼓中厚皮片、网状中厚皮片、保留真皮下血管网皮瓣联合负压封闭引流技术（VSD）治疗四肢大面积皮肤撕脱伤的疗效。方法根据伤情应用反鼓取中厚皮片和不断蒂真皮下血管网皮瓣联合负压封闭引流技术修复12例大面积皮肤撕脱伤。根据皮肤损伤特点,将血运差的皮肤修剪成中厚皮片和（或）网状中厚皮片,蒂部周围血运正常皮肤,简单修剪皮下脂肪使其成真皮下血管网皮瓣,负压封闭引流材料覆盖中厚皮片区,持续吸引5~7d。结果 10例创面一期封闭,2例经负压封闭吸引后,有部分皮片坏死感染创面,经过二次邮票植皮完全愈合。出院后全部使用弹力绷带包扎6月,随访6~12个月,真皮下血管网皮瓣和中厚皮片部位无瘢痕增生,网状中厚皮片部位少量瘢痕增生,功能均恢复满意。结论四肢大面积皮肤撕脱伤根据伤情皮肤一期回植联合负压封闭引流治疗,手术方法简单、实用、并能一期覆盖大部分创面,减少感染,降低渗出,加快创面的愈合,缩短病程。

Objective To summarize the therapeutic effect in the treatment of large area avulsion skin injuries of limbs among anti-drum intermediate split-thickness skin graft,mesh intermediate split-thickness skin graft and sub-dermal vascular network skin-flap with vacuum sealing drainage（VSD）.Methods Depending on the specific cases,we used anti-drum intermediate split-thickness skin graft and sub-dermal vascular network skin-flap with vacuum sealing drainage to repair 12 cases of large areas of skin avulsed injury.Based on the characteristics of skin damage,we cut the skin of poor blood into intermediate split-thickness skin graft and /or mesh intermediate split-thickness skin graft.If the skin＇s blood was normal,we simply pruned subcutaneous fat to sub-dermal vascular network skin-flap.All the cases continued with the treatment for 5～7d with vacuum sealing drainage.Results 10 cases closed in one stage.2 cases with vacuum sealing drainage had some skin graft necrosis infection.They healed completely through secondary stamps graft.All of them used elastic bandages for 6 months,and then were followed up for 6 to 12 months.No scar hyperplasia occurred in sub-dermal vascular network skin-flap and intermediate split-thickness skin graft,and slight scar hyperplasia in mesh intermediate split-thickness skin graft.The functions were satisfactorily recovered.Conclusion The application of skin-grafting with vacuum sealing drainage to treat large area avulsion skin injuries of limbs is simple and practical and can cover most of a wound,reduce infection and accelerate wound healing.