中国修复重建外科杂志

中国修复重建外科杂志

自制肢体慢性创面闭合装置在瘢痕性下肢创面修复中的应用

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目的探讨自制肢体慢性创面闭合装置在下肢瘢痕性及复杂皮肤软组织缺损修复中的应用。方法2014 年 1 月—2017 年 1 月,收治 29 例下肢复杂骨折合并皮肤软组织缺损患者。其中男 19 例,女 10 例;年龄 21~66 岁,平均 31.1 岁。致伤原因:交通事故伤 14 例,高处坠落伤 5 例,重物挤压伤 4 例,机器辗压伤 4 例,骨折术后钢板外露 2 例。骨折及皮肤缺损部位:小腿胫腓骨骨折并皮肤缺损 26 例,跖骨骨折并足背皮肤缺损 3 例。皮肤缺损范围为 5 cm×3 cm~18 cm×8 cm。受伤至入院时间 5~31 d,平均 14.3 d。患者均采取彻底清创、伤口敞开引流,自制肢体慢性创面闭合装置结合 Ilizarov 牵张技术行皮肤软组织缓慢牵拉。待创面清洁、肉芽组织新鲜,两侧皮肤靠拢后二期根据实际创面大小植皮或直接缝合封闭创面。结果患者术后均获随访,随访时间 8~20 个月,平均 13 个月。29 例患者经肢体慢性创面闭合装置结合 Ilizarov 技术牵拉治疗 1~2 次,平均 1.3 次后感染得到控制,肉芽组织生长良好。治疗过程中患者疼痛不明显,依从性好。创面均达临床愈合,无皮肤牵拉并发症发生,创面仅形成线状或片状瘢痕。结论自制肢体慢性创面闭合装置修复下肢复杂瘢痕性创面效果较好,且手术难度小,可操作性强。

ObjectiveTo investigate the effectiveness of self-made limb chronic wound closure device in the treatment of scarred lower limbs and complex skin and soft tissue defects.MethodsBetween January 2014 and January 2017, 29 patients with complex fractures of the lower extremities and skin and soft tissue defects were treated. There were 19 males and 10 females with an average age of 31.1 years (range, 21-66 years). The causes of injury included 14 cases of traffic accidents, 5 cases of falling from height, 4 cases of heavy object crushing injury, 4 cases of mechanical crushing injury, and 2 cases of exposed steel plate after fracture. There were 26 cases of calf fracture and skin defect, 3 cases of metatarsal bone fracture and skin defect of the foot. The skin defect ranged from 5 cm×3 cm to 18 cm×8 cm. The time from injury to admission was 5-31 days, with an average of 14.3 days. All patients underwent a thorough debridement, open wound drainage, self-made chronic wound closure device combined with Ilizarov stretching technique for a slow skin and soft tissue traction. After the wound was cleaned up and the granulation tissue was freshened, the skins on both sides were closed, and then proceed to the second stage operation of skin grafting or direct suture closure based on the size of the wound.ResultsAll patients were followed up 8-20 months, with an average of 13 months. Twenty-nine patients were treated with self-made chronic wound closure device combined with Ilizarov technique for 1-2 times with an average of 1.3 times, then the wound infection was controlled and the granulation tissue grew well. In the course of treatment, the pain was not obvious and the patients had good compliance. All patients’ wounds healed clinically without skin traction complications and formed linear or flaky scars.ConclusionThe self-made chronic wound closure device is effective in repairing complex scarred wounds of lower extremities, and it is easy to operate.

关键词: 瘢痕性创面; 软组织缺损; 创面闭合; Ilizarov 技术

Key words: Scarred wound; soft tissue defect; wound closure; Ilizarov technique

引用本文: 浦绍全, 吕乾, 赵泽雨, 胡丹, 陈向, 陈汉芬, 朱跃良, 徐永清. 自制肢体慢性创面闭合装置在瘢痕性下肢创面修复中的应用. 中国修复重建外科杂志, 2019, 33(2): 219-222. doi: 10.7507/1002-1892.201803045 复制

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