简易外部皮肤扩张术治疗Pilon骨折术后皮肤坏死缺损

Simple external skin expansion technique in treatment of skin necrosis defect after the surgery for Pilon fracture

目的探讨简易外部皮肤扩张术在治疗Pilon骨折术后皮肤坏死中的价值。方法回顾性分析2015年5月—2017年1月采用简易外部皮肤扩张术治疗的12例Pilon骨折术后皮肤坏死缺损患者资料。其中男10例,女2例;年龄32~58岁,平均(45.30±8.91)岁;开放性骨折4例,闭合性骨折8例;缺损部位长约9.1 cm、宽约3.9 cm;3例为开放性骨折部位皮肤坏死,9例为术后手术切口部位皮肤坏死。皮肤坏死部位彻底清创排除感染后,克氏针间断穿过皮肤,在克氏针两端各绕一个无菌橡胶管与对侧创缘的克氏针两端相连接,给予适度拉力,拉力大小以两侧皮缘仍有渗血、皮肤颜色无明显苍白为度,两端橡胶管以止血钳固定。利用皮肤的延展性和橡胶管的拉力作用使皮肤逐渐延伸,逐渐缩小并缝合创面。所有患者术后随访3~6个月,观察手术疗效。结果术后12例患者创面均愈合,愈合时间为2~4周,平均(2.50±0.59)周。12例患者全部牵张成功后直接间断缝合,其中4例患者因在外露内置物或肌腱表面牵张缝合,致使部分牵张皮肤延迟愈合,再次缝合后愈合。牵张后的皮肤色泽正常、毛发生长正常、弹性良好、无臃肿且触痛觉正常。结论简易外部皮肤扩张术治疗Pilon骨折术后皮肤坏死缺损是一种简单、有效、经济的方法,值得临床推广。

Objective To evaluate the clinical effects of simple external skin expansion technique in treatment of skinnecrosis defect after the surgery for Pilon fracture. Methods Data of 12 patients with skin necrosis defect after the surgeryfor Pilon fracture treated with simple external skin expansion technique in our hospital from May 2015 to January 2017 wereretrospectively analyzed. There were 10 males and 2 females in the 12 patients with age 32-58 years old(average 45.30±8.91 years old). There were 4 cases with open fractures and 8 cases with closed fractures. The defect area was about 9.1 cmlong and 3.9 cm wide. There were 3 cases with skin necrosis of open fractures and 9 cases with postoperative skin necrosis ofincision site. After completely debridement and removing infection from the skin necrosis areas, kirschner needle wiredintermittented through the skin, the kirschner wire was around a sterile silicone rubber tube at both ends and the kirschnerwire was connected to the both ends of the Kirschner on the opposite side. After giving moderate tensile force, which showedthat the skin on both sides was still bleeding, no obvious pale color on skin, two ends of rubber tube were fixed with forceps.Using the ductility of skin and the tensile force of sterile silicone rubber tube to gradually extend the skin and to graduallynarrow and close the suturing wound. All patients were followed up for 3-6 months to observe the effect of surgery. Results All of the 12 cases were healed in 2-4 weeks, average(2.50±0.59) weeks. The patients were sutured directly after simpleexternal skin expansion, and 4 patients were sutured with the surface of the external plate or tendon, and parts of wound weredelayed healed after the re-suture. The skin color, lustre, hair growth and elasticity were normal, no bloated, and tendernesswas normal after simple external skin expansion. Conclusion The simple external skin expansion technique in treatment ofskin necrosis defect after the surgery for Pilon fracture is a simple, effective and economic method, which is worthy of clinicalpromotion.