中国修复重建外科杂志

中国修复重建外科杂志

应用皮肤牵张器闭合胫骨骨折术后皮肤软组织缺损

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目的 探讨应用皮肤牵张器闭合胫骨骨折术后皮肤软组织缺损的l疗效。 方法 2016 年 4 月—2017 年 3 月,采用皮肤牵张器治疗 15 例胫骨骨折术后皮肤软组织缺损患者。其中男 11 例,女 4 例;年龄 24~59 岁,平均 37.5 岁。致伤原因:交通事故伤 7 例,重物砸伤 3 例,高处坠落伤 3 例,摔伤 2 例;均无神经及血管损伤。闭合骨折 3 例,首次手术采用切开复位钢板螺钉内固定术;开放骨折 12 例,首次手术均采用创面清创、外支架固定术。首次手术后 1~3 个月小腿皮肤软组织缺损仍未恢复,缺损范围为 14 cm×5 cm~20 cm×7 cm,均为长条形或梭形皮肤缺损。在皮肤缺损纵轴线两侧的皮肤边缘穿入克氏针,然后以皮肤牵张器扣锁两侧克氏针后适当收紧,根据皮缘血供及小腿肌肉受压情况,及时调整牵张器的张力,待皮缘相互接触时去除克氏针及牵张器,行皮肤间断缝合术。术后每 3 天进行伤口愈合情况评分,直至伤口拆线。 结果 15 例皮肤软组织缺损经 6~13 d 牵张均得到覆盖,间断缝合后 12 d 伤口均愈合拆线。伤口愈合情况评分从术后当天的(3.40±0.51)分降至术后 12 d 的(1.27±0.46)分,差异有统计学意义(t=12.911,P=0.000)。15 例患者均获随访,随访时间 4~12 个月,平均 6.5 个月。牵张后皮肤色泽、弹性及痛触觉均与正常皮肤相似,毛发生长正常。术后出现 1 例钉道感染和 2 例小腿不适感,经治疗后症状均缓解。 结论 利用皮肤牵张器闭合胫骨骨折术后皮肤软组织缺损是一种有效的手术方法。

Objective To discuss the efficacy of skin stretcher applied for repair of postoperative skin and soft tissue defects in tibia fractures. Methods Between April 2016 and March 2017, 15 cases with skin and soft tissue defects after tibia fractures fixation were treated with the skin stretcher. There were 11 males and 4 females with an age of 24-59 years (mean, 37.5 years). The causes of injury included traffic accident in 7 cases, bruise in 3 cases, falling from height in 3 cases, and falling in 2 cases; without nerve and vascular injury in all patients. These cases were followed up 1-3 months after their first surgery, consisting of 3 closed fractures treated with open reduction and plate and screw fixation, 12 open fractures treated with external fixation after debridement. The area of skin defects ranged from 14 cm×5 cm to 20 cm×7 cm, all of which were stripped or spindle shaped skin defects. First, the skin was penetrated by two Kirschner wires which were locked by skin stretchers on both sides of the skin defect longitudinally. Then, the tension of skin stretchers was timely adjusted according to the skin flap blood supply and muscle compression. Finally, Kirschner wires and skin stretchers were removed when the edge of skin contacted and been sutured. Clinical score of wound healing were measured every 3 days until suture removal on postoperative at 12 days. Results All skin and soft tissue defects of 15 cases were covered after stretching for 6-13 days. The interrupted sutured wounds healed at 12 days. Clinical scores of wound healing decreased from 3.40±0.51 at immediate postoperatively to 1.27±0.46 at 12 days postoperatively, showing significant difference (t=12.911, P=0.000). All the patients were followed up 4-12 months (mean, 6.5 months). After stretching, the skin color, elasticity, and pain and touch feeling were similar with the normal skin, and the hair growth was normal. After operation, 1 case of nail tract infection and 2 cases of calf discomfort occurred, and all were relieved after treatment. Conclusion It is an effective surgery for repairing postoperative skin and soft tissue defects in tibia fractures with the application of skin stretchers.

关键词: 胫骨骨折; 皮肤缺损; 皮肤牵张

Key words: Tibia fractures; skin defects; skin stretching

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