亚急诊修复四肢软组织缺损

Subemergent repair of soft tissue defects in the four limbs

目的 :探讨亚急诊修复四肢软组织缺损的可行性。方法 :本院于 1990～ 1999年共收住 40 3例四肢软组织缺损病人 ,运用带蒂皮瓣、游离皮瓣及植皮方法在不同时期进行修复 ,其中急诊手术 12 4例 ,亚急诊(急诊清创后 1～ 5天 )手术 16 3例 ,晚期 (5天以后 )手术 116例。同时对三组病例术后感染率、皮瓣坏死率及功能恢复情况进行统计研究。结果 :亚急诊手术感染率为 3.7% ,急诊手术感染率为 3.2 % ,晚期手术感染率为 3.4% ;吻合血管的游离皮瓣移植病例 ,亚急诊手术坏死率为 4.8% ,急诊手术坏死率为 8.3% ,晚期手术坏死率为 7.4%。三组病例术后感染率、游离皮瓣移植术后坏死率差异无显著性 (P >0 .0 5 )。 114例单纯手背皮肤缺损行皮瓣修复术后手指活动功能比较结果显示 ,亚急诊手术优良率为 87.2 % ,急诊手术优良率为 90 .5 % ,晚期手术优良率为 6 4.0 %。亚急诊与急诊病例术后功能优良率差异无显著性 (P >0 .0 5 ) ,而与晚期病例差异有显著性 (P <0 .0 5 ) ,前者优于后者。结论 :亚急诊期为急诊清创后 1～ 5天较妥 ,此时修复四肢软组织缺损能兼顾急诊和晚期手术的利弊 ,临床实施安全可靠。

Objective:To explore the possiblity of sub-emergent repair of the soft tissue defects.Methods:From 1990 to 1999, 403 cases with the soft tissue defects in the four limbs were repaired by the pedicled flaps, free flaps, and full thickness or split thickness grafting. 124 of them were repaired emergently, 163 of them were repaired subemergently, 116 of them were repaired in late stage. A retrospective analysis has been made.Results:The necroses rate, infection rate of subemergent repair did not show difference from the other groups(P>0.05). Their function was better than that in the later period repaired cases(P<0.05).Conclusion:Subemergent repair gives enough consideration to the advantages of emergent repair and the disavantages of late stage repair. It is safety in clinical application.