阴茎皮肤及阴囊完全撕脱伤的一期急诊修复

Complete avulsion of penile and scrotal skin: Emergency one-off repair

目的探讨应用转移皮瓣对阴茎皮肤及阴囊大面积撕脱伤的治疗。方法选择1999—2012年笔者所在医院收治8例阴茎皮肤及阴囊完全撕脱伤患者,其中机器绞伤6例,挤压伤并合并多器官损伤2例;合并一侧精索完全断裂并睾丸脱除2例。所有8例均采用轴性转移皮瓣修复,选择之皮瓣轴性蒂为会阴邻区;7例为伤后6 h内;1例为伤后72 h,撕脱皮肤原位缝合后坏死外院转入。结果手术均一期修复成功。术后随访1～4年,皮瓣愈合良好。1例术后阴茎形态略显臃肿,行皮下纤维组织切除。1例皮瓣皮缘坏死约1.5 cm×3.0 cm,1年后局部创缘瘢痕化,无功能障碍。其余无性功能障碍,无睾丸萎缩及尿道狭窄。结论对会阴部损伤致阴茎皮肤及阴囊严重撕脱伤患者,应准确评估患者的损伤程度,急诊下选择转移皮瓣进行修复,在保证生命体征平稳的同时,首先应考虑阴茎、睾丸、精索等重要器官功能的保护,同时依据伤情及皮肤受损程度,确定转移皮瓣,以期获得最佳治疗效果。

Objective To explore the application of flap transfer to the skin of the penis and scrotum for repairing large area of avulsion. Methods There were 8 patients with complete avulsion of penile and scrotal skin in author＇s hospital from 1999 to 2012yr., among them 6 cases were of machine strangulation injury, 2 cases of crush injury associated with multiple organ injury, 2 cases of one side of the spermatic cord complete fracture and testis removal. All the cases were treated by axial flap, which was from perineal adjacent area, 7 cases of whom were operated on within 6 hours after injury; 1 case was operated on within 72 hours after injury and were obeserved for necrosis outhorn after the avulsed skin suture in situ. Results All the cases were treated by one - off repair operation successfully. All the flaps healed well found by postoperative follow-up of 1--4years, postoperative penile morphology of one patient was slightly bloated and subjected to a subcutaneous fibrous tissue resection operation. The size of skin flap margin necrosis of 1 case was approximately 1.5 cmx3.0 cm, which was no dysfunction although scar formation after 1 year. The rest cases had no erectile dysfunction, testis atrophy and urethral stricture. Conclusion The patients with the severe penis and scrotum avulsion injuries due to perineal injury should be subjected to an accurate assessment on the extent of injury, and repaired with selecting transfer flap under emergency. At the same time of keeping vital signs stable, the first consideration should be given to the penis, testicles, spermatic cord and other important organ for function protection, and according to the degree of injury and skin damage to determine the flap to be transfered so that just the best treatment effect can be obtained prespectively.