小儿四肢皮肤撕脱伤治疗体会

Experience in Pediatric Treatment of Limb Skin Laceration

目的探讨小儿四肢皮肤撕脱伤的治疗体会。方法彻底清创，创面处理根据皮肤撕脱伤的特点，采用自体大块游离皮片植皮42例，局部转移皮瓣加植皮21例，撕脱皮肤处理后原位再植15例，术后加强抗感染等对症处理。结果78例患者皮瓣完成活率95％以上，无皮肤组织感染，功能恢复良好；7例患者有部分皮肤坏死（成活率85％-90％），经换药处理后均完全愈合；二期植皮26例，原位再植坏死后大块异体皮加自体微粒皮移植1例，予再次清创处理，创面新鲜后二次手术植皮，愈合良好，功能恢复较好。结论根据小儿四肢皮肤撕脱伤的特点，采取相应的植皮方式，均能起到良好的术后恢复效果。

Objective To summarize some experience in pediatric treatment of skin avulsion injuries. Methods De- bridement was performed. Application of autologous free skin graft （42 cases）, local skin flap and skin graft （21 cases）, and back implantation of the lacerated skin （15 cases） were chosen in accordance with the specific situation of the wounds Antibiotics and other symptomatic treatment were applied postoperatively. Results Flap survival rate （with the function restored） in the 78 patients reached 95%, with no skin infections noted. Partial skin necrosis was noted in 7 patients （85% to 90% survival rate） and completely healed after dressing. Secondary skin transplant was performed in 26 cases. Transplantation of allogeneic microskin mixed with autologous microskin after post - in situ back implantation necrosis was performed in one case after re - debridement on fresh wound, which healed and restored function postoperatively. Conclusion Appropriate ways of transplantation chosen accord- ing to the characteristics of skin avulsion can exert good postoperative recovery effects.