改良腹部真皮下血管网皮瓣联合负压引流技术在手背部创面的应用

Application of Dermal Vascular Network Flap Combined with Vacuum Sealing Drainage Technique Used in the Wound on the Back Hand

目的:探讨改良腹部真皮下血管网皮瓣联合负压吸引技术修复手背部创面的临床效果。方法:2013年5月-2015年10月笔者科室收治手背及指背部损伤患者16例,清创、按受伤指背个数及创面大小设计腹部真皮下血管网皮瓣(11cm×11cm^16cm×14cm),皮瓣中间纵向剖开形成双蒂,在双蒂皮瓣近指蹼处开窗;把修剪下的医用海绵填塞指间,供瓣区覆盖医用海绵,缝合、固定;皮瓣缝合于手背创面,术后给予间歇式负压封闭冲洗引流,每天3次,冲洗10~14d后去除生物半透膜,14~21d断蒂、分指,供瓣区用局部皮瓣封闭。结果:14例皮瓣顺利成活;1例皮瓣第2天皮瓣下积血,处理后消退,皮瓣成活;1例断蒂后皮瓣远端坏死,换药后局部麻醉下植皮。2例术后7d负压引流管堵塞,注射器冲洗后通畅;3例半透薄膜漏气,局部封闭。患者平均住院时间为33.5d。术后随访6~18个月,患者手指形态及功能恢复较好,手术效果满意。结论:表明改良腹部真皮下血管网皮瓣联合负压引流技术修复手背部创面是一种有效可行的方法。

Objective To discuss the effect of the treatment of subdermal vascular network skin flap combined with vacuum sealing drainage technique for wound on back hand region. Methods Collected 16 patients with wounds on the hand back or finger regions from May 2013 to October 2015. After applied debridement treatment, grouped them according to the number of the injured areas and the size of the wounds（11cm×11cm-16cm×14cm）. Cut the skin flaps longitudinally from middle to form bi-pedicle shape and packed with medical sponge. Covered the donated areas with medical sponge, sutured them and applied VSD treatment three times a day for the following 10-14 days. Then removed the Biological membrane and the donated skin areas closed around 14-21 days after. Results There were 14 cases with skin flap survived, hyphemia for 1 case but disappeared after treatment, necrosis for 1 case, 2 cases with blocking of negative pressure drainage tube for 7 days but unobstructed after syringe flushing, 3 cases with semi permeable membrane leakage and partial closure. The average time was 33.5d for hospitalization. The patients were followed up for the next 6 to 18 months and their wound regions recovered very well. All of the patients were satisfied with the effects. Conclusion All the above indicated that the treatment of subdermal vascular network skin flap combined with vacuum sealing drainage technique for wound on hand back regions is effective and feasible.