中国修复重建外科杂志

中国修复重建外科杂志

改良可调式皮肤牵张闭合器在皮肤及软组织缺损修复中的应用

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目的 探讨一种改良可调式皮肤牵张闭合器在皮肤及软组织缺损修复中的应用。 方法 2016 年 3 月—2017 年 4 月,应用改良可调式皮肤牵张闭合器(根据皮肤边缘的颜色、温度、毛细血管反应、肿胀程度决定调节压力的大小及调节次数)修复 21 例皮肤及软组织缺损。男 11 例,女 10 例;年龄 21~67 岁,平均 49.2 岁。小腿截肢术后遗留创面 1 例;创伤性外伤术后 18 例,其中位于小腿 4 例、膝关节 3 例、上肢 7 例、足部 4 例;糖尿病足 2 例。皮肤缺损范围 4.0 cm×2.5 cm~21.0 cm×10.0 cm。 结果 4 例创面术中一期闭合;12 例创面经术后持续牵拉 5~14 d,平均 10 d 后闭合;5 例创面缩小为原 1/2 以内,二期植皮或皮瓣修复后愈合。21 例患者均获随访,随访时间 3~12 个月,平均 5.2 个月。创缘皮肤呈线性愈合,瘢痕小,无创缘血运不畅、坏死、皮肤感觉功能差等并发症发生。 结论 应用改良可调式皮肤牵张闭合器能缩小皮肤及软组织缺损面积,甚至直接闭合创面,无需后期植皮及皮瓣修复,为临床治疗皮肤及软组织缺损提供了一种可供选择的方法。

Objective To investigate the application of modified adjustable skin stretching and secure wound-closure system in repairing of skin and soft tissue defect. Methods Between March 2016 and April 2017, 21 cases of skin and soft tissue defects were repaired with the modified adjustable skin stretching and secure wound-closure system (the size of regulating pressure and the times of adjustment were determined according to the color, temperature, capillary response, and swelling degree of the skin edge). There were 11 males and 10 females, with an average age of 49.2 years (range, 21-67 years). Among them, 1 case was the residual wound after amputation of leg; 18 cases were the wounds after traumatic injury operation, including 4 cases in the lower leg, 3 cases in the knee joint, 7 cases in the upper limb, and 4 cases in the foot; and 2 cases were diabetic feet. The skin defect area ranged from 4.0 cm×2.5 cm to 21.0 cm×10.0 cm. Results Skin defect wounds closed directly in one stage in 4 cases; 12 cases were closed after continuously stretching for 5-14 days (mean, 10 days); 5 cases were reduced to less than one-half area, and the wound healed after the second skin grafting or flap repairing. All the 21 patients were followed up 3-12 months (mean, 5.2 months). The wound was linear healing with small scar, and no invasive margin, poor blood flow, necrosis, and poor sensory function happened. Conclusion The modified adjustable skin stretching and secure wound-closure system can reduce the skin and soft tissue defects or close the wound directly, and even replace the skin graft and skin flap repairing. It was a good method for the treatment of skin and soft tissue defect.

关键词: 皮肤缺损; 皮肤牵张闭合器; 改良方法; 修复; 皮肤伸展术

Key words: Skin defect; skin stretching and secure wound-closure system; modified method; repair; skin-stretching expansion

引用本文: 董其强, 谷国俊, 王礼军, 付科达, 谢书强, 张松建, 张华峰, 吴召森. 改良可调式皮肤牵张闭合器在皮肤及软组织缺损修复中的应用. 中国修复重建外科杂志, 2017, 31(12): 1481-1484. doi: 10.7507/1002-1892.201707103 复制

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