四肢皮肤逆行撕脱伤治疗方案及创面处理

The Treatment of Retrograde Avulsion Injury of Extremities Skin and Wound Covering

四肢皮肤逆行撕脱伤是比较严重的损伤,在临床上比较多见且治疗困难。皮肤逆行撕脱伤是机械及其他的外力作用导致皮肤和皮下组织从深筋膜浅面强行撕脱,同时可能伴有不同程度的软组织碾压伤。受伤原因多见于压面机碾压、机器绞伤、机器牵拉、手动器械挫伤等。比如手外科常见为手背皮肤逆行撕脱,通常连同手背静脉网,以及伸肌腱腱周膜浅层,甚至连同伸肌腱一同逆行撕脱,此种情况临床上较为常见,治疗起来颇为棘手,损伤较重者往往会发生软组织坏死,甚至会导致功能丧失。如何正确处理皮肤撕脱皮肤,是严重创伤诊治中经常遇到的难题。现将各种治疗方案进行对比,为临床治疗提供更为准确的思路。

Retrograde avulsion of the limb skin is a more serious injury, which is common in clinic and dif-ficult to treat. Retrograde avulsion of the skin is caused by mechanical and other external forces that force the skin and subcutaneous tissue to avulsion from the superficial surface of deep fas-cia, and may be accompanied by different degrees of soft tissue crushing injury. The cause of in-jury is more in the face press, machine wound, machine pull, and manual instrument contusion. For example, in hand surgery, retrograde avulsion of dorsal hand skin is common, which is usu-ally accompanied by dorsal hand vein network, superficial layer of extensor tendon peritendi-nous membrane, and even retrograde avulsion of extensor tendon. This situation is relatively common in clinical practice and difficult to treat. How to treat skin avulsion correctly is a com-mon problem in the diagnosis and treatment of severe trauma. Now the various treatment plans are compared to provide more accurate ideas for clinical treatment.