负压封闭引流联合Lando~?人工真皮并结合自体皮移植应用于手足部骨肌腱外露伴骨折创面的临床研究

Clinical study of vacuum sealing drainage combined with Lando~? artificial dermis combined with autologous skin grafting for the treatment of wounds with bone and tendon exposure and bone fracture of hand and foot

目的探讨应用负压封闭引流联合Lando■人工真皮并结合自体皮移植修复手足部骨肌腱外露伴骨折创面的临床效果。方法选取2017年11月至2019年2月郑州仁济医院创伤显微外科收治的手足部骨肌腱外露伴骨折的35例患者(手部23例,足部12例)。一期先行骨折复位,彻底清创和止血后,使用负压封闭引流装置进行创面床准备。二期行Lando■人工真皮移植,待创面完全血管化后,揭除硅胶膜,移植自体皮。术后随访6~12个月,观察植皮成活情况和远期外观恢复情况。结果35例患者人工真皮覆盖术后10~15 d拆除负压装置,支架血管化良好,完全覆盖裸露的骨肌腱。自体皮移植术后除1例因未及时引流而导致植皮部分坏死,经换药后再次植皮创面愈合,其余患者移植的自体皮片基本存活。术后6~12个月随访发现,移植区无破溃,皮肤颜色与周围正常皮肤颜色接近,无明显瘢痕和挛缩形成,未发生肌腱粘连,功能恢复满意。结论负压封闭引流联合Lando■人工真皮并结合自体皮移植修复手足部骨肌腱外露创面,可直接覆盖外露骨肌腱,术后移植区外观恢复平整,功能恢复良好,值得推广。

Objective To investigate the clinical effect of vacuum sealing drainage combined with artificial dermis combined with autologous skin grafting for the treatment of wounds with bone and tendon exposure and bone fracture of hand and foot.Methods Thirty-five patients(including 23 cases of hand and 12 cases of foot with bone and tendon exposure and bone fracture of hand and foot were treated in the Department of Trauma Microsurgery,Zhengzhou Renji Hospital from November 2017 to February 2019.The fracture was fixed at the first stage,wound debridement and hemostasis following.Wound bed was prepared with vacuum sealing drainage device,and after that,Lando■artificial dermis was applied.After complete vascularization,the silicone membrane was removed and the autologous skin was applied.Follow-up was performed for 6 to 12 months,and skin graft survival situation and long-term recovery appearance were performed.Results Thirty-five patients removed the negative pressure device 10 to 15 days after the artificial dermal covering,the stent vascularized well and completely covered the exposed bone and tendon.After autogenous skin graft transplantation,except for one case,which caused partial necrosis of the skin graft due to failure to drain in time,the skin graft wound was healed again after dressing change,and in the rest of the patients the transplanted autologous skin graft basically survived.The transplanted autologous skin survived completely.The follow-up results of 6 to 12 months after operation showed that the wound was not broken,and the skin color was close to that of the surrounding normal skin.There was no obvious scar hyperplasia and tendon adhesion,and the functional recovery was satisfactory.Conclusions Vacuum sealing drainage combined with Lando■artificial dermis combined with autologous skin graft repair of exposed bones and tendons of the hands and feet,which can directly cover exposed bones and tendons.The appearance of the transplanted areaand the function is well,which is worth popularizing.