摘要
目的 :总结应用负压封闭引流(VSD)结合间断开窗技术促进大面积跟腱外露创面肉芽组织生长后植皮修复的临床效果。方法:2009年7月至2014年5月收治跟腱大面积外露创面患者11例,其中男5例,女6例;年龄7~65岁,平均43岁。重物擦挫伤致皮肤坏死4例,胫腓骨远端骨折术后皮肤坏死3例,车轮夹伤致皮肤坏死3例,糖尿病致皮肤坏死1例。跟腱外露面积6 cm×3 cm^14 cm×5 cm,均无跟腱断裂及骨质外露。清创后于跟腱表面以尖刀片和跟腱纵轴平行间断开窗,结合负压封闭引流(VSD)治疗。结果:所有创面经1个VSD周期(5~7 d)吸引后,均有丰富新鲜肉芽组织生成,Ⅱ期植皮后均成活。患者均获随访,时间12~24个月,皮片色泽良好,质地柔软,无破溃。术后3~4个月皮片下即有皮下脂肪生成,皮肤滑动满意,踝关节活动良好。无迟发型跟腱断裂发生。结论:负压封闭引流(VSD)结合间断开窗技术修复大面积跟腱外露创面,简便易行,安全有效,可最大程度减少患者行皮瓣修复创面所带来的副损伤。
Objective：To explore clinical effect of vacuum sealing drainage（VSD） combined with discontinuous windowing technique for repairing large area exposed wounds of Achilles tendon. Methods：From July 2009 to May 2014,11 patients with large exposed wounds of Achilles tendon were treated,including 5 males and 6 females with an average age of 43 years old（aged from 7 to 65 years old）. Among them,4 cases were skin necrosis caused by heavy objects abrasion and contusion; 3cases were caused by distal tibiofibula fractures;3 cases were caused by bicycle spoke injuries;1 case was caused by diabetes.Areas of exposed Achilles tendon were from 6 cm×3 cm to 14 cm×5 cm without tendon rupture or bone exposed. After debridement,discontinuous fenestration on Achilles tendon was made by knife blade parallel with longitudinal axis of Achilles tendon,combined with Vacuum Sealing Drainage（VSD） treatment. Results：After drainage treatment with one VSD cycle（5 to 7days）,abundant fresh granulation tissues were growing on all wounds and survived well after the second phase dermatoplasty.All patients were followed up for 12 to 24 months,the color of skin flap was good,the texture was soft without burst. At 3 to 4months after operation,subcutaneous fat was appeared under the flap,the skin was sliding,movement of ankle joints was good.No delayed Achilles tendon rupture were occurred. Conclusion：Vacuum sealing drainage（VSD） combined with discontinuous fenestration is a simple,safe and effective method for repairing large area exposed wounds of Achilles tendon,which could minimize the secondary damage caused by wounds of skin flap grafting.
出处
《中国骨伤》
CAS
2015年第12期1153-1155,共3页
China Journal of Orthopaedics and Traumatology
关键词
负压封闭引流
跟腱
软组织损伤
皮肤开窗术
外科手术
Vacuum sealing drainage（VSD）
Achilles tendon
Soft tissue injuries
Skin window technique
Surgical procedures
operative
