真皮下血管网层反取皮回植联合负压封闭引流在下肢大面积皮肤撕脱伤中的应用

Application of reverse dermal revascularization combined with vacuum sealing drainage in the large area of skin avulsion of the lower extremities

目的:总结下肢大面积皮肤撕脱伤后急诊给予真皮下血管网层反取皮回植联合负压封闭引流后的临床疗效。方法:收集2010年7月至2018年3月收治的30例下肢大面积皮肤撕脱伤患者的临床资料。男20例,女10例;年龄16~67(48±13)岁。车祸伤19例,碾轧伤11例。受伤至手术时间3~10(5±1) h。所有病例给予I期彻底清创,真皮下血管网层反取皮植皮后多切口引流结合负压封闭引流技术覆盖7~10 d。拆除VSD观察创面成活情况:如果坏死面积大,需清创切痂待创面肉芽生长满意后择期再次取皮植皮术;小面积坏死皮肤加强换药直至愈合。结果:30例均获随访,时间7~48(20±11)个月。无一例出现感染,30例经Ⅰ期成活面积均达到85%以上;5例皮肤坏死范围在12%左右,Ⅱ期经再次清创游离植皮后愈合,其余患者经过加强换药后均获愈合。真皮下血管网层回植的皮肤颜色、弹性、感觉、耐磨耐压性良好,各关节活动良好,未见明显皮肤粘连引起肢体活动受限。结论:真皮下血管网层回植联合负压封闭引流治疗下肢大面积皮肤撕脱伤,可大大降低了创面感染率,促进了皮片与创面的贴敷,利于引流,提高了反取皮的成活率,改善了下肢关节功能。

Objective:To summarize the clinical effect of emergency subcutaneous vascular network reverse skin replantation combined with vacuum sealing after drainage of large area skin avulsion injury.Methods:Clinical data of 30 patients with extensive skin avulsion of the lower limb treated between July 2010 and March 2018 were collected.There were 20 males and 10 females,ranging in age from 16 to 67 years old,with an average of(48±13)years old.Cause of injury:19 cases of car accident injury,11 cases of crush injury.The surgery time was 3 to 10 h,with an average of(5±1)h.All cases were completely debrided in stage I.The subdermal vascular network was reversed and skin grafted with multiple incision drainage combined with negative pressure closed drainage technique for 7 to 10 days.The wounds were removed by VSD observation:if the necrotic area is large,debridement is required.After the granulation growth of the wound is satisfactory,the skin grafting is performed again after electrification;the small area of necrotic skin strengthens the dressing and heals.Results:30 patients were followed up for 7 to 48 months,with an average of(20±11)months.No infection in 1 case appeared,30 patients,living area more than 85%of the wound after treatment survival in the stageⅠ;The skin necrosis ranged from about 12%in 5 patients in the stageⅡ.The second stage was healed after redebriding free skin grafts.The other patients were healed after the dressing,capillary meshwork layer of skin color,good elasticity,feeling,wearable pressure,each joint activities is good,no obvious skin adhesion cause physical activity is limited.Conclusion:Reverse skin grafting combined with VSD for the treatment of large skin avulsion of lower limb can greatly reduce wound infection rate,promote the application of skin and wound,conducive to drainage,improve the survival rate of reverse skin grafting and improve the function of lower limb joints.