利用分期渐进牵张的皮肤缝合技术治疗软组织缺损的临床观察

Treatment of soft tissue defect by progressive stretch skin suture technique

回顾性分析2016年9月至2021年1月武汉大学中南医院采用分期渐进牵张皮肤缝合(简称"牵张缝合")技术治疗的14例皮肤软组织缺损患者资料。其中男性10例、女性4例,年龄13~73岁,缺损部位为足踝、小腿等,缺损面积(2~3)cm×(2~3)cm至(3~6)cm×(5~9)cm。均根据皮肤创面情况每3~6天行局部麻醉后清创、分期渐进牵张缝合2~4次、抗感染治疗直至创面消失。其中2例伴骨折,均在行外固定支架固定骨折后行牵张缝合;4例创面细菌培养阳性患者包括2例金黄色葡萄球菌、1例大肠埃希菌、1例阴沟肠杆菌感染,均清创、分期渐进牵张缝合并根据药敏试验结果予敏感抗生素抗感染治疗,创面闭合时感染治愈;3例皮肤脱套严重的,入院当天仅行清创处理,待第2次清创及以后则行清创、分期渐进牵张缝合。愈合时间10~23(17.2±3.8)d,治疗期间未出现皮缘坏死等情况。术后随访≥6个月,末次随访愈合后的皮肤柔软度、感觉功能、血供情况均正常,温哥华瘢痕评估量表评分平均为3.1分,其中优9例(0~3分)、良5例(4~7分),患者对皮肤牵张缝合疗效满意。提示分期渐进牵张的皮肤缝合技术治疗软组织缺损操作简单,治疗效果好。

Clinical data of 14 patients with skin and soft tissue defects treated by progressive stretch skin suture(stretch suture)in Zhongnan Hospital of Wuhan University from September 2016 to January 2021 were retrospectively analyzed.There were 10 male and 4 female aged 13-73 years.The ankle and calf were the main defect sites with the defect area ranged from 2-3 cm×2-3 cm to 3-6 cm×5-9 cm.According to the wound skin condition,patients received progressive stretch suture 2-4 times after debridement and anti-infection treatment until the wounds were completely healed.Two patients with fractures underwent skin stretch after fracture fixation with external fixators.There were 4 patients with wound infection,including 2 cases infected with Staphylococcus aureus,1 with Escherichia coli,and 1 with Enterobacter cloacae,all of whom received antibiotic therapy and infection was controlled and the progressive stretch suture was performed.In 3 patients with severe degloved skin injury,the infection was treated with debridement on the first day,and stretch suture was not performed until the second debridement.The soft tissue defect wound healed completely in 10-23 days,with an average of(17.2±3.8)days.None of the patients had skin necrosis during the stretch suture treatment.The postoperative follow-up time was more than 6 months and the skin softness,sensory function and blood supply of the patients were normal,and the average Vancouver Scar Scale score was 3.1,among whom 9 cases were scored as excellent(0-3 points)and 5 as good(4-7 points).The patients were satisfied with the effect of skin stretch,the study suggests that the progressive stretch skin suture technique is simple and effective in treatment of soft tissue defect.