四肢脱套伤的处理

Management of degloving injuries of limbs

四肢皮肤脱套伤是一种常发生于车祸和工业意外的严重的损伤,由于皮肤和皮下的肌肉、肌腱、筋膜分离,皮肤和皮下组织受损严重,有时还可能会损伤到骨、关节以及其它的组织。如果对伤情估计不足或者是没有得到及时的处理,会引起较多的并发症甚至增加患者的死亡率。虽然由于患者的损伤程度不同,并且在诊疗过程中外科医生的观念也有所差异。但是无论选择哪种处理措施,都是以尽可能恢复肢体功能,尽量减少残疾的发生为目的。

Degloving injuries of limbs occur relatively rarely but pose extreme challenges to surgeons, which are usually caused by traffic accidents or industrial trauma. The key point that differentiates this kind of injury from others is that certain arteries will get damaged due to the separation of the skin and subcutaneous soft tissues from muscles, tendons and fascias, leading to the block of blood flow. Loss of blood supply means the degloving skin and other soft tissues can hardly live. Mismanagement of such kind of injuries may result in delayed full-thickness necrosis of the avulsed skin flap, higher complication rate, increased hospitalization and rehabilitation cost, even greater risk of amputation and death. By reviewing past scholars＇ management of different types of degloving injuries, it is found that although there are many options available for the management, it is still disputed on how to choose effective treatment strategies and techniques. Some traditional methods are efficient and can be easily put into use in clinic. With the development of science and technology in recent years, new technologies and materials like microsurgical techniques and vaccum sealing drainage（ VSD） / vaccum assisted closure（ VAC） can provide new options for these injuries, which could greatly reduce the heavy nursing care burden after surgery and decrease the postoperative infection rate. This article is introducing the classification of degloving injuries of limbs, storage methods of degloved skin and discussing the treatment strategies, surgical techniques and prognosis of this kind of injury, aiming to provide some recommendations to surgeons who will face these injuries.