改良可调式皮肤牵张闭合器在皮肤及软组织缺损修复中的应用

Application of modified adjustable skin stretching and secure wound-closure system in repairing of skin and soft tissue defect

目的探讨一种改良可调式皮肤牵张闭合器在皮肤及软组织缺损修复中的应用。方法 2016年3月—2017年4月,应用改良可调式皮肤牵张闭合器(根据皮肤边缘的颜色、温度、毛细血管反应、肿胀程度决定调节压力的大小及调节次数)修复21例皮肤及软组织缺损。男11例,女10例;年龄21~67岁,平均49.2岁。小腿截肢术后遗留创面1例;创伤性外伤术后18例,其中位于小腿4例、膝关节3例、上肢7例、足部4例;糖尿病足2例。皮肤缺损范围4.0 cm×2.5 cm^21.0 cm×10.0 cm。结果 4例创面术中一期闭合;12例创面经术后持续牵拉5~14 d,平均10 d后闭合;5例创面缩小为原1/2以内,二期植皮或皮瓣修复后愈合。21例患者均获随访,随访时间3~12个月,平均5.2个月。创缘皮肤呈线性愈合,瘢痕小,无创缘血运不畅、坏死、皮肤感觉功能差等并发症发生。结论应用改良可调式皮肤牵张闭合器能缩小皮肤及软组织缺损面积,甚至直接闭合创面,无需后期植皮及皮瓣修复,为临床治疗皮肤及软组织缺损提供了一种可供选择的方法。

Objective To investigate the application of modified adjustable skin stretching and secure wound- closure system in repairing of skin and soft tissue defect. Methods Between March 2016 and April 2017, 21 cases of skin and soft tissue defects were repaired with the modified adjustable skin stretching and secure wound-closure system （the size of regulating pressure and the times of adjustment were determined according to the color, temperature, capillary response, and swelling degree of the skin edge）. There were 11 males and 10 females, with an average age of 49.2 years （range, 21-67 years）. Among them, 1 case was the residual wound after amputation of leg; 18 cases were the wounds after traumatic injury operation, including 4 cases in the lower leg, 3 cases in the knee joint, 7 cases in the upper limb, and 4 cases in the foot; and 2 cases were diabetic feet. The skin defect area ranged from 4.0 cmx2.5 cm to 21.0 cmxl0.0 cm. Results Skin defect wounds dosed directly in one stage in 4 cases; 12 cases were closed after continuously stretching for 5-14 days （mean, 10 days）; 5 cases were reduced to less than one-half area, and the wound healed after the second skin grafting or flap repairing. All the 21 patients were followed up 3-12 months （mean, 5.2 months）. The wound was linear healing with small scar, and no invasive margin, poor blood flow, necrosis, and poor sensory function happened. Conclusion The modified adjustable skin stretching and secure wound-closure system can reduce the skin and soft tissue defects or close the wound directly, and even replace the skin graft and skin flap repairing. It was a good method for the treatment of skin and soft tissue defect.