反取皮植皮并封闭负压引流治疗下肢大面积皮肤撕脱伤

Back implanatation of skin graft combining vaccum sealing drainage in the treatment of large skin avulsion of lower extremities

目的总结反取皮植皮联合封闭负压引流（vacuum sealing drainage,VSD）治疗下肢大面积皮肤撕脱伤的临床疗效。方法 2010年1月至2012年12月,收治的下肢大面积皮肤撕脱伤患者13例的临床资料。男8例,女5例;年龄4-59岁,平均36岁。致伤原因：车祸伤10例,机器碾轧伤3例。受伤至手术时间2-12h,平均3h。所有病例均先行急诊手术室彻底清创,反取皮植皮法缝合固定创面,VSD 5-12天,视创面及反取皮成活情况,小面积皮肤坏死缺损部分行邮票式游离植皮。结果本组13例获12-36个月随访,平均16个月。患者无1例发生明显感染,经反取皮植皮联合VSD治疗患者创面75%以上面积成活,对于小部分皮肤坏死创面,后期经邮票式游离植皮或清洁换药后均获愈合,术后膝关节功能良好。结论反取皮植皮联合VSD治疗下肢大面积皮肤撕脱伤,早期关闭了开放创面,在大大降低了感染率的同时,促进了皮片与创面的贴覆,提高了创面愈合率,改善了关节功能。

Objective To investigate the efficacy of back implanatation of skin graft combining vacuum sealing drainage （ VSD ） in the treatment of large skin avulsion of lower extremities. Methods From January 2010 to December 2012, data of 13 cases with large area skin avulsion injury in lower extremities were collected. Among them, 8 cases were males and 5 cases were females. The average age was 36 years old （ range： 4-59 years ）. Causes：traffic accident in 10 cases, machine crush injury in 3 cases. The mean time from injury to surgery was 3 hours （ range：2-12 hours ）. All cases underwent emergency operation by debridement, back implanatation of skin graft to suture wound, and enclosed pressure suction drainage with VSD for 5 to 12 days. Depending on the wound and skin survival, stamp type free skin graft was performed in small areas of skin necrosis defect. Results All 13 patients were followed up. The average follow-up was 16 months （ range： 12-36 months ）. Infection was not found and more than 75% of the skin graft survived. Small areas of skin necrosis healed in the later stamp type free skin grafting or clean dressing. Postoperative knee functions were good. Conclusions Back implanatation of skin graft combining VSD in the treatment of large skin avulsion of lower extremities enjoys advantages of early closure of open wounds, promotion of the stick plying-up between the graft and wound while greatly reducing the infection rate, and improvement of the wound healing rate and joint functions.