摘要
目的探讨交通伤所致下肢严重皮肤撕脱伤的手术治疗方法。方法对2000年12月～2005年6月因交通伤所致的下肢严重皮肤撕脱伤68例患者的治疗进行回顾性分析。治疗方法采用彻底清创后行骨折固定、血管神经修复，用四种处理方法行创面皮肤覆盖。原位缝合8例（外院处理后转入患者）；急诊植皮或皮瓣移植修复38例，其中皮瓣修复26例，返削植皮12例；延迟一期修复15例，即急诊清创后观察3～7d，再进行第二次清创，采用植皮或皮瓣修复创面；二期处理7例中有3例采用游离股前外侧皮瓣移植，2例采用肌皮瓣转位并植皮，2例返削植皮，对因一期处理不当致皮肤坏死或形成皮下囊肿患者采用再次返削植皮。结果原位缝合中1例大部分皮肤成活，7例大面积皮肤坏死。急诊皮瓣完全成活26例，1例边缘部分坏死，其中皮瓣结合皮片移植9例均完全成活，急诊返削植皮12例中10例一期成活，有2例皮片部分坏死。延迟一期修复植皮除1例部分失活，其余皮瓣完全成活。二期处理中皮瓣及植皮均成活。本组患者随访6个月～5年（平均18个月），皮肤创面均完全覆盖，肢体功能恢复：优38例，良23例，差7例，优良率为89．7％。结论准确判断皮肤撕脱伤所累及组织的伤情、安排周密的术前计划、合理选用创面修复方法是确保皮肤撕脱伤肢体功能获得最大程度恢复的关键。
Objective To study repair of severe massive avulsion injuries in the lower limbs caused by traffic accidents. Methods Sixty-eight patients with severe massive avulsion injuries in the lower limbs caused by traffic accidents were treated from December 2000 to June 2005 in our department. After thorough debridement, fixation of fractures and repair of vessels and nerves, 4 methods were adopted to repair the raw wounds. Suturation in situ was performed in 8 cases, emergency dermatoplasty or flap transfer in 38 cases, delayed one-stage repair with dermatoplasty or flap grafting in 15 cases, and management by two stages in 7 cases, including 3 cases of flap transfer, 2 cases of myocutaneous flap transposition plus dermatoplasty, and 2 cases of skin regrafting. Results Suturation in situ resulted in 1 case of most survival and massive skin necrosis in 7 cases. Emergency flap transfer resulted in 26 cases of complete survival, and emergency dermatoplasty resulted in 10 cases of primary healing and 2 cases of partial necrosis. Delayed one-stage repair and the second managements resulted in complete survival of skin grafts, except one partial necrosis. The follow-ups ranged from 6 months to 5 ）,ears. All skin wounds were covered. The limb function was excellent in 38 cases, good in 23 cases, poor in 7 cases, with the excellent-to-good rate being 89.7%. Conclusion Precise evaluation of the severity of the injury, careful preoperative planning and correct repair measures are key points for successful treatment of severe massive avulsion injuries in the lower limbs caused by traffic accidents.
出处
《中华创伤骨科杂志》
CAS
CSCD
2007年第11期1034-1037,共4页
Chinese Journal of Orthopaedic Trauma
关键词
下肢
皮肤损伤
外科皮瓣
Lower limbs
Avulsion injury
Surgical flaps
