吻合回流静脉治疗上肢皮肤大面积套脱伤

Venous anastomosis in the degloved skin for treating large size soft tissue degloving injury of the upper limb

目的 探讨吻合回流静脉治疗上肢皮肤大面积套脱伤的临床效果.方法 自2009年3月至2011年12月,我们以显微外科技术修复套脱皮肤内的浅静脉,重建血液回流通路治疗上肢皮肤大面积套脱伤患者5例.结果 本组病例套脱皮肤大部分成活,有散在的浅层坏死,经切痂植皮术后愈合.术后随访1.5个月至半年,患肢皮肤质地柔软,血供充分,手指屈伸活动好.患者对肢体外形及功能满意.结论 应用显微外科技术吻合回流静脉治疗肢体皮肤大面积套脱伤,可最大限度地恢复损伤皮肤的血液循环,确保皮肤的成活及外形与功能.

Objective To investigate the clinical outcomes of venous anastomosis in the degloved skin for treating large size soft tissue degloving injury of the upper limb.Methods From March 2009 to December 2011 microsurgical anastomosis of 3 to 4 superficial veins within the degloved skin was carried out when suturing the skin back in 5 cases of large size degloving injury of the upper limb.Results Most of the degloved skin survived.Sporadic superficial skin necrosis occurred but was successfully treated by debridcment and skin graft.After follow-up of 1.5 to 6 months,the re-attached skin was found to be pliable and well perfused.Finger movements were good.Satisfactory aesthetic and functional results were achieved.Conclusion Microsurgical anastomosis of the draining veins in the re-attached skin can improve the survival of large size degloved skin of the upper limb by reducing venous congestion and restoring blood circulation.It also improves the quality of the skin and hence the aesthetic and functional outcomes.