体表多部位难愈创面的整形治疗

Plastic treatment of multisite refractory wounds on body surface

目的:对不同部位难愈创面进行分析总结,从中筛选出系统有效的治疗措施。方法:术前处理:换药、红光和烧伤治疗仪烤创面,清除坏死组织,封闭负压治疗,皮瓣及皮片修复重建。结果:治疗128例,伤口Ⅰ期愈合81例,愈合率63.28%;延期愈合45例,愈合率35.15%;2例创面大部分愈合,愈合率0.01%。下肢股骨中段和胫骨中段截肢各1例,上肢肱骨中段截除1例,指中、末节指骨截除5例6指、趾截除4例6趾。结论:手术修复的成败在于术前处理,经过换药、红光灯烤,封闭负压等系统有效的创面准备,使局部感染明显减轻,局部环境变化。血供的改善和全身低蛋白血症的纠正,加之带血供皮瓣的移植,给手术成功奠定了良好的基础,使难愈创面在短时间内全部治愈。

Objective：To summarize the experiences in treating different sites of refractory wounds and screen for systematic and effective treatment measures.Methods： The preoperative processing included dressing change,infrared light and instrument treatment,removal of necrotic tissue,vacuum-assisted closure therapy,and skin flap transplantation as well as skin grafting.Results： Among 128 cases of burns,81 obtained primary healing（cure rate 63.28%）,45 obtained delayed healing（cure rate 35.15%） and 2 obtained majority healing（cure rate 0.01%）.There were one femur amputation,one tibia amputation,one humerus amputation,five middle and distal phalanx amputation with 6 fingers and 4 toe amputation with 6 fingers.Conclusion： The key step of surgical repair lies in preoperative processing.The pretreatment such as dressing change,infrared light treatment,vacuum-assisted closure therapy controlled local infection,improved local environment and blood supply,and lessened hypoproteinemia.The skin flap transplantation also help to provide good foundation for the success of operation,and thus making refractory wound healed in a short period of time.