筛网状全厚皮片移植联合封闭负压引流治疗四肢皮肤缺损

Treatment of limb skin defects by delayed cribriform-shaped full thickness skin graft associated with vacuum sealing drainage

目的探讨全厚皮片延期移植联合封闭负压引流(VSD)治疗四肢皮肤缺损的临床效果。方法对38例外伤性四肢皮肤缺损患者行清创+VSD术,待缺损区创面肉芽新鲜时,行筛网状全厚皮片移植并用VSD敷料覆盖,持续负压吸引,3～5 d后去除VSD敷料。结果 38例均获随访,时间3个月～2年。35例皮片一次全部成活,3例皮片边缘少许坏死伴渗液,经换药治愈;植皮区外观满意,弹性好,无瘢痕挛缩;取皮区留有线形瘢痕,无瘢痕增生、疼痛等。结论筛网状全厚皮片联合VSD延期植皮修复四肢皮肤缺损成活率高,外观满意,疗效好。

Objective To explore clinical application of delayed cribriform-shaped full thickness skin graft associated with vacuum sealing drainage （VSD） to treat limb skin defects. Methods After effective debfidement combined with VSD, dermatoplasty was performed on 38 limb skin defect patients by using cribriform-shaped tull thickness skin grafts together with VSD on fresh granulation. VSD provided continuous negative pressure aspiration and was t＇emoved 3 to 5 days postoperation. Results All 38 patients were followed up for a period of 3 months to 2 years. 35 flail thickness skin grafts survived completely; 3 suffered from partial necrosis at the edge, but healed by dressing changes. The appearance of the skin graft was satisfied and elasticity was good with no scar contracture; there was only a linear sear remains visible at harvesting area with no scar hyperplasia and pain, etc. Conclusions Delayed cribriform-shaped full thickness skin graft accompanied by VSD is an effective method to treat limb skin defects with higher survival rate and satisfactory appearance.