负压封闭引流与传统的打包加压技术在治疗足部皮肤撕脱伤中的临床效果比较

Comparison of Clinical Effects of Vacuum Sealing Drainage and Traditional Packing and Compression Techniques in the Treatment of Foot Skin Avulsion

目的:通过对比分析皮肤原位回植结合负压封闭引流技术(VSD)和皮肤原位回植结合打包植皮治疗足部皮肤撕脱伤的临床效果来探讨两种治疗方法的优劣性。方法:2011年1月至2016年9月急诊采用皮肤原位回植结合VSD技术和皮肤原位回植结合打包植皮治疗50例足部皮肤撕脱伤,25例接受了VSD结合皮肤原位回植术为实验组,25例接受了传统打包结合皮肤原位回植术为对照组。观察两组单个患者植皮成活百分比、创面感染率、皮下血肿发生率、手术用时、住院时间、换药次数、二次手术率。结果:实验组术后单个患者植皮成活百分比高于对照组,差异具有统计学意义(97.2±5.97%VS84.2±13.61%,P<0.05),实验组的手术时间、住院时间和换药次数少于对照组,差异具有统计学意义(P<0.05)。实验组的感染率、皮下血肿发生率、二次手术修复率低于对照组,差异具有统计学意义(P<0.05)。结论:急诊采用皮肤原位回植结合VSD负压吸引技术治疗足部皮肤撕脱伤相较于传统的皮肤原位回植结合打包加压法,可以提高单个患者植皮成活百分比,减少皮肤创面感染和产生皮下血肿率,减少需二期手术修复的几率和缩小需二期修复的创面面积,缩短手术时间、住院时间,换药次数。

Objective： To discuss the advantages and disadvantages of the two treatment methods,by comparing and analyzing the clinical effects of skin replantation in situ combined with vacuum sealing drainage（ VSD） and skin in situ replantation combined with packing skin grafting for the treatment of foot skin avulsion injury. Methods： 50 cases with foot skin avulsion injury were treated with emergency skin in situ replantation combined with VSD technique and in situ replantation combined with skin grafting from January 2011 to September 2016. 25 cases were underwent VSD combined with in situ skin replantation as experimental group,and other 25 cases were accepted the traditional package with in situ skin replantation as control group. The percentage of skin grafting,the rate of wound infection,the rate of subcutaneous hematoma,the time of operation,the length of hospital stay,the number of dressing change and the reoperation rate were observed in two groups. Result： After the emergency operation,the per patient＇s survival rate of skin graft of VSD group is 97.2±5.97% and the traditional packaging technology group is 87. 2 ± 13. 61 %.（ p〈0. 05）. The hospitalization time,operative time,and the times of postoperative dressing change of experimental group were significantly shorter than those of control group（ p〈0. 05）. The reoperation rate and the occurrence rates of infection and subcutaneous hematoma of experimental group were lower than those of control group（ p〈0. 05）. Conclusions： The emergency use of skin in situ replantation in situ skin with VSD suction treatment of foot skin avulsion injury compared to traditional replantation combined with packing pressure method,can improve the individual patients with skin graft survival percentage,reduce the skin wound infection and subcutaneous hematoma rate,reduce the probability the second stage operation to repair and reduce the need to repair the wound area,shorten the operation time,hospitalization time,dressing change times.