地震伤员开放伤口的手术治疗策略

Managements of open wounds from an earthquake

目的 探讨地震伤员开放伤口的手术处理方法.方法 总结5· 12汶川地震中于2008年5月12-26口转入华西医院骨科接受手术治疗的51例开放伤口伤员的术前情况、手术治疗方法及术后效果.51例中,开放骨折8例,切开减张创面6例,骨外露8例,单纯皮肤软组织缺损29例.创面感染率100％.共进行60次手术,手术方法：皮瓣、肌皮瓣手术4例,植皮术30例（包括邮票植皮、整张植皮和网状植皮）,创面负压引流治疗（NPWT）2例,扩创术24例.结果 4例皮瓣、肌瓣手术后皮瓣、肌瓣成活良好；30例植皮手术皮片成活率均达到90％以上；2例NPWT、24例扩创术后创面感染减轻,继续换药处理或择期手术.结论 恰当的创面手术处理方法可以加速地震伤员开放创面的愈合、最大限度地保存功能.

Objective To explore the surgical managements of open wounds from 5 · 12 Wenchuan Earthquake.Methods In this report,fifty one patients with open wounds were treated after transported into West China Hospital from May 12 to 26 in 2008 after 5 · 12 Wenchuan Earthquake.Among 51 cases,open wounds were due to open fractures （n =8）,fasciotomy （n =6）,exposed bone （n =8） and defects of skin and soft tissue （n =29）.All cases had wound infections.Sixty operations were performed,including muscle and myocutaneous flap （ n =4 ）,skin grafting （ n =30 ）,NPWT （ negative pressure wound therapy ） （ n =2 ）and debridement （ n =24 ）. Results Four cases of muscle and myocutaneous flaps survived with an excellent blood circulation.And 30 cases of skin grafting had a survival rate of over 90%,2 cases of NPWT and 24 cases of debridement required further treatment.Conclusion With adequate surgical managements,open wound healing from an earthquake may be accelerated and the functions maximally preserved.