皮肤伸展术在火器伤中应用时机的研究

Study on time window to employ skin-stretch technique in fire-armed injury

目的 探讨火器伤后开始皮肤牵张的最佳时机。方法 将 12头白色家猪制成火器伤软组织缺损后 ,分为牵张组和非牵张组 ,致伤后均立即清创。牵张组分别于清创后当即和 1、2、3、4天开始牵张 ,并观测创周组织含水量、伤缘皮肤温度及创周皮肤牵张后的变化 ,同时用光镜观察组织学改变。结果 组织含水量 2天时最高 ,此后下降 ;火器伤后伤缘皮肤温度进行性增高 ;清创后 2天内开始皮肤牵张易引起牵张处豁裂 ,同时局部血循环差 ;2天后开始牵张则情况明显改善。组织学观察发现 ,创周组织 2天后水肿减轻 ,但细菌和中性粒细胞增多。结论 伤后最早牵张时机为伤后 2天 ,2～ 3天最佳 ;超过

Objective To explore the substantial opportunity to employ early skin stretch after fire armed injury.Methods 12 pigs were divided into 2 groups, after fire armed soft tissue deficient and the primary debridement were performed.No stretch was performed in the non stretch group (2 swine) and skin stretch was conducted to each of subject in the study group(10 swine) on the 1,2,3,4 day respectively after the debridement. The tissue water content,temperature,histological and macroscopic changes in the wound edge tissue were observed.Results The water content was the highest on the second day and got decreased afterwards. The temperature was progressively elevated. Laceration would happened to the stretched area if the stretch procedure started within 2 days after debridement.At this time,local circulation was poor. After 2 days,the situation could be much better. Histologically,edema in peri wound tissue emproved,but the numbers of bacteria and neutrophil got increased.Conclusions The stretch technique should be employed 2 days later after injury. The optimal time for skin stretch was between 2 and 3 days after injury. If it was applied later than this time,infection would get serious.