急诊一期带蒂全厚皮片原位回植联合VSD治疗四肢开放性皮肤脱套伤疗效分析

Efficacy analysis of emergency first-stage pedicled mesh full-thickness skin graft in situ combined with VSD in the treatment of open skin degloving injuries of extremities

目的 探讨急诊一期行带蒂网状全厚皮片原位回植联合VSD治疗四肢开放性皮肤脱套伤的疗效。方法 自2018年8月~2021年6月急诊收治的44例四肢开放性皮肤脱套伤患者,一期原位植皮应用VSD患者25例(VSD组),使用传统加压包扎患者19例(对照组)。所有创面自脱套边缘以远向蒂部脱脂处理,修剪为带蒂全厚皮片,“品”字形打孔后原位回植于缺损区,对照组传统加压包扎固定,VSD组以敷料半透明膜封闭包裹整个创面,持续负压引流,术后以规范护理干预,对比两组患者平均住院时间、皮片成活率和并发症发生率等情况,评价远期局部感觉及外观形态。结果 所有患者均随访,随访时间5~18个月。术后VSD组患者植皮区均全部成活,回植皮片成活率(99.04%)高于对照组(91.05%);VSD组成活效果优22例,良2例,差1例,其术后并发症发生率(2.78%)低于对照组(31.25%),差异均有统计学意义(P<0.05);同时统计两组患者的平均住院时间,VSD组短于对照组(P<0.05)。远期观察随访VSD组患者治疗的总有效率为96%,显著高于对照组74%(P<0.05);且VSD组患者局部皮肤色泽可,质地良好,弹性接近正常,未出现因瘢痕挛缩导致肢体功能障碍。结论 急诊一期采取带蒂网状全厚皮片原位回植联合VSD治疗四肢开放性皮肤脱套伤,相较传统术式提高了回植皮片存活率,缩短了手术疗程,并发症较少,疗效确切,可获得满意效果。

Objective To evaluate the effect of in situ replantation of pedicled reticular full thickness skin graft combined with VSD in the treatment of open skin degloving injury of extremities.Methods From August 2018 to June 2021,44 patients with open skin degloving injury of extremities were treated in the emergency department, including 25 patients with VSD and 19 patients with traditional pressure bandage.All wounds were degreased from the degloving edge to the pedicle, trimmed into full-thickness skin grafts with pedicle, and replanted in the defect area after "pin" shaped perforations.The control group was fixed with traditional pressure bandage, and the observation group was covered with VSD dressings, sealed with continuous negative pressure drainage.Standard nursing intervention was given after the operation.The average hospitalization time, skin graft survival rate and complication rate of the two groups were compared to evaluate the long-term local sensation and appearance.Results All patients were followed up for 5 to 18 months.After operation, all the skin graft areas in the observation group survived, and the survival rate of skin graft was 99.04% higher than that in the control group(91.05%);The postoperative complication rate(2.78%) was lower than that of the control group(31.25%)(P<0.05);The average hospitalization time in the observation group was shorter than that in the control group(P<0.05).The total effective rate of the observation group was 96%,which was significantly higher than that of the control group(74%)(P<0.05).Conclusion In the first stage of emergency treatment, the pedicled reticular full-thickness skin graft in situ replantation combined with VSD can improve the survival rate of the replantation skin graft, shorten the surgical course, have fewer complications, have a definite effect, and can obtain satisfactory results compared with the traditional operation.