全臂皮肤脱套伤1例报告

One Case Report of Full-arm Degloved Skin Injury

目的总结全臂皮肤脱套伤的治疗体会。方法对2016年9月腾冲市人民医院骨科收治的1例全臂皮肤脱套伤患者采用剥脱皮肤原位回植+VSD+湿润烧伤膏换药治疗,观察治疗效果,总结治疗体会。结果术后21 d,创面愈合良好,患者出院,并于门诊继续行湿润烧伤膏换药治疗;出院后24 d,创面完全愈合,左上肢外观基本恢复,肩关节功能恢复至伤前水平,肘、腕及手部功能恢复良好;出院后1年随访,部分愈后皮肤可见增生性瘢痕,Highet皮肤感觉S3级,Moberg 2PD <15 mm,肌力Ⅳ～Ⅴ级,肘、腕及手部功能基本恢复至伤前水平。结论早期剥脱皮肤原位回植+VSD+湿润烧伤膏换药,并结合患者的全身情况给予其科学的全身综合治疗与护理以及早期功能锻炼指导可有效提高皮瓣成活率,最大程度保留患肢功能,值得临床参考借鉴。

Objective To summarize the experience of treating full-arm degloved skin injury. Methods One patient with full-arm degloved skin injury admitted into the Orthopedics Department of Tengchong People＇s Hospital in September 2016 was treated with exfoliated skin in situ replantation plus Vacuum Sealing Drainage（ VSD） and MEBO,and the treatment effect was observed and the experience was summarized. Results On day 21 after the exfoliated skin in situ replantation,the wound was healed well and the patient was discharged from the hospital to receive dressing change of MEBO and debridement of necrotic tissues at the outpatient visit. On day 24 after discharge,the wound was completely healed,the appearance of left upper arm was basically restored,the shoulder joint can function as well as before,and the functions of elbow,wrist and hand restored well. One-year follow-up after discharge found partial scar hyperplasia on the healed skin,Highet skin sensation was Level S3,Moberg 2 PD 15 mm,muscle strength grade IV-V,and the functions of elbow,wrist and hand restored to pre-injury levels. Conclusion In addition to the scientific and systemic treatments and nursing based on patients＇ general condition and early functional exercise guidance,the early exfoliated skin in situ replantation plus VSD and the dressing change of MEBO can effectively improve the survival rate of skin flaps and retain the functions of affected limbs as much as possible. The combined therapy could be a reference treatment method for degloved skin injury in clinical practice.