中国修复重建外科杂志

中国修复重建外科杂志

延时皮肤牵拉器在皮肤软组织缺损治疗中的应用

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目的 总结延时皮肤牵拉器治疗皮肤软组织缺损的临床效果。 方法 2014 年 12 月—2016 年 12 月,采用延时皮肤牵拉器治疗皮肤软组织缺损 10 例。男 6 例,女 4 例;年龄 42~64 岁,平均 53 岁。急性创伤致皮肤软组织缺损 6 例,骨筋膜室综合征切开后切口无法闭合 3 例,巨大痈切开引流后皮肤软组织缺损 1 例。缺损部位:大腿 4 例,小腿 3 例,上臂 2 例,背部 1 例。缺损范围为 10 cm×4 cm~22 cm×12 cm。创缘行 Pinch 试验,确认创面均无法直接闭合。 结果 牵拉过程中,3 例出现张力性水疱;无 1 例出现创缘血运不畅、皮肤坏死等并发症。10 例患者创面经过 7~18 d 持续牵拉后明显缩小,均直接拉拢缝合;无 1 例行植皮或游离皮瓣手术。术后创口愈合良好。10 例患者均获随访,随访时间 5~8 个月,平均 6.5 个月。创缘周围均无坏死,瘢痕呈线性,感觉及功能不受影响。 结论 采用延时皮肤牵拉器治疗皮肤软组织缺损操作简单、手术风险低、并发症少,可获得较好疗效。

Objective To summarize the effectiveness of delayed skin-stretching device in treatment of skin and soft tissue defects. Methods Between December 2014 and December 2016, 10 cases of skin and soft tissue defects were treated with delayed skin-stretching device. There were 6 males and 4 females with an average age of 53 years (range, 42-64 years). The skin and soft tissue defects were caused by acute trauma in 6 cases. The incision could not be closed directly after making incisions because of osseous fascia syndrome in 3 cases. The skin soft tissue defect caused after huge carbuncle incision and drainage in 1 case. The defect located at thigh in 4 cases, lower leg in 3 cases, upper arm in 2 cases, back in 1 case. The defect area ranged from 10 cm×4 cm to 22 cm×12 cm. Pinch test was performed on the wound margin, which confirmed that the wound could not be closed directly. Results Tension blisters were found in 3 cases during traction, and no complications such as impaired blood circulation and skin necrosis occurred in all cases. Skin defects closed directly after continuously stretching for 7–18days. No skin graft or free flap repair was performed in all patients. The wound healed well after operation. All the 10 patients were followed up 5-8 months (mean 6.5 months). There was no necrosis around the wound margin and the scar was linear. The sensation and function were not affected. Conclusion Delayed skin-stretching device is an effective means to treat skin and soft tissue defects, which has the advantages of simple operation, low risk of operation, less complications, and reliable effectiveness.

关键词: 皮肤软组织缺损; 延时皮肤牵拉器; 皮肤牵张法

Key words: Skin and soft tissue defect; delayed skin-stretching device; skin stretching

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