跟腱外露难愈创面的封闭式负压吸引治疗

Vacuum-assisted closure treatment of achilles tendon exposed refractory wounds

目的：总结封闭式负压引流（vacuum-assisted closure,VAC）技术治疗跟腱外露创面的良好效果,为这类创面修复提供更好的治疗方法.方法：2007年1月-2014年3月,笔者应用VAC治疗18例跟腱外露患者,其中跟腱断裂术后9例,车祸伤4例,重物卡压伤2例,钢绳切割伤1例,Ⅲ度烧伤1例,Ⅲ度电击伤1例.围手术期准备后,尽快手术扩创,行创面VAC治疗.结果：所有创面经VAC治疗后,创面明显缩小,肉芽生长迅速,部分或全部覆盖外露肌腱,其中12例全部被肉芽组织覆盖,行薄中厚皮片移植修复,11例患者一期愈合.余仍有部分肌腱外露者,5例行邻近皮瓣修复,全部一期愈合;1例行人工真皮加自体刃厚皮片移植一次性修复,所有创面一期愈合率达94.4％.所有患者均随访6月-3年,无复发,局部无挛缩,功能恢复良好.结论：VAC治疗跟腱外露难愈创面,明显缩短疗程,有效防治肌腱坏死,减少手术创伤及治疗疼痛,提高愈合质量.

Objective To summarize the result of vacuum-assisted closure （VAC） treatment of Achilles tendon exposed refractory wounds,and provided a better method to treat these wounds.Methods Eighteen patients with Achilles tendon exposed refractory wounds,hospitalized from January 2007 to March 2014,were treated with VAC.The tendon of postoperative wound infection of skin soft tissue necrosis （9 cases）,car accident injury skin and soft tissue defect （4 cases）,heavy conformity of skin soft tissue necrosis （2 cases）,steel cord cutting injury skin and soft tissue defect （2 cases）,thirddegree burn （1 cases）,third-degree electrical injury （1cases）.All the patients were given systemic supporting treatment in perioperative period and early debridement,and were treated with VAC.Results After VAC treatment,all wounds significantly reduced,the fresh granulation tissue formed rapidly in all cases,some or all of the covering exposed tendons,12 patients were all covered with granulation tissue exposed tendons.12 cases with thin thickness skin graft to repair,11 patients were primary healing;5 patients with adjacent flap repair,all patients were primary healing; 1 patients with artificial dermis and autologous split-thickness skin graft one-time repair,all wound primary healing rate was 94.4％.All patients were followed up for 6 months to 3 years,no recurrence,local no contracture,good functional recovery.Conclusion VAC treatment of Achilles tendon exposed refractory wound,significantly shorten period of treatment,the effective prevention and treatment of tendon necrosis,reduce the surgical trauma and pain treatment,improve the quality of healing.