Masquelet技术结合游离植皮治疗老年慢性难愈创面的临床应用

Masquelet technique combined with skin graft in treatment of chronic refractory wounds in elderly patients

目的:介绍应用Masquelet技术结合游离植皮治疗老年慢性难愈创面的手术方法和临床效果。方法:2020年9月-2022年9月,温州医科大学附属第二医院创面修复外科对20例下肢伴有骨骼或肌腱外露的慢性难愈创面的老年患者应用Masquelet技术,在治疗患者基础疾病的同时,经过多次清创后携抗生素骨水泥封闭创面,在创面诱导膜充分形成后,应用游离植皮覆盖四肢难愈创面。创面缺损面积4.5 cm×3.0 cm~15.0 cm×6.0 cm,所有软组织缺损创面均伴有肌腱或者骨外露。术后定期来院门诊复诊,并通过电话、视频等方式随访,观察患者创面愈合情况以及取皮区有无相关并发症。采用下肢功能量表(LEFS)评分评价下肢功能恢复情况。结果:本组20例术后均定期随访,时间3~12个月,平均7.6个月。第一阶段手术进行创面膜诱导1~4次,平均(1.3±0.7)次,第二阶段在创面诱导膜上进行游离植皮,20例植皮全部成活,无坏死和感染发生;植皮区皮肤外观及质地满意,术后LEFS评分为(69.83±10.82)分。结论:Masquelet技术结合游离植皮治疗老年难愈性创面,可取得满意的临床效果,可降低手术风险,简单可靠,是修复方式的一种有效补充。

Objective To introduce a surgical method and clinical effect of using Masquelet technique combined with skin graft to cover chronic refractory wounds in elderly patients.Methods From September 2020 to September 2022,20 elderly patients with wounds of bone or tendon exposure in lower limbs were treated in the Department of Wound Repair,the Second Affiliated Hospital of Wenzhou Medical University.Due to the age and poor general condition of the patients,flap transfer for wound coverage were not allowed.Masquelet technique was therefore applied in the treatment of chronic wounds of such patients.Sizes of wounds were found at 4.5 cm×3.0 cm to 15.0 cm×6.0 cm and all accompanied with tendon and bone exposure,after thorough debridement.Wounds were then sealed with antibiotic bone cement several times.After having induced formation of membrane in wounds,free mesh skin graft was used to cover the refractory wounds.The patients were entered in follow up regularly after surgery at outpatient service,and telephone or video reviews.The wound healing of patients and whether there were related complications in the skin donor area were observed.The number of operation times in the first stage was 1-4 with an average of 1.3 times±0.7 times.Lower Extremity Function Scale(LEFS)was used to evaluate the recovery of lower limb function.Results All 20 wounds healed well.The follow-up time was 3-12 months,with an average of 7.6 months.The appearance and texture of the skin in the wounds area were satisfactory.The mean LEFS was 69.83 point±10.82 point.Conclusion Using Masquelet technique combined with free skin grafting to treat refractory wounds in the elderly patients can achieve satisfactory clinical outcomes.It is a simple and reliable supplement to the wound repair,and can reduce the surgical risk.