目的:研究封闭式负压引流术加撕脱皮片原位回植在四肢皮肤撕脱伤中的应用效果.方法:收集整理2008年6月至2009年7月入院25例四肢皮肤撕脱伤患者,采用封闭式负压引流术加撕脱皮片原位回植治疗,其中男19例,女6例;年龄21～57岁,平均41岁.清创后创面行常规真皮下血管网皮片或中厚皮片原位回植修复加多聚乙烯醉明胶海绵材料覆盖封闭,24 h不间断吸引,应用VSD技术7～14 d,拆除VSD后观察皮肤颜色、皮肤存活率及撕脱皮肤感觉功能.结果:使用VSD技术后感染得到控制,16例患者皮片存活率96%以上,7例皮片存活率90%以上,2例皮片出现边缘表皮坏死,换药后治愈.4周后回植皮肤颜色基本正常,质地柔软耐磨,无压迫性溃疡,撕脱皮肤感觉功能恢复可.结论:封闭式负压引流术结合真皮下血管网皮片或中厚皮片原位回植,在关闭创面的同时进行创面的引流,降低感染的发生,促进创面良好的贴附,是治疗四肢皮肤撕脱伤较好的方法.%Objective:To investigate the therapeutic effectes of vacuum sealing drainage (VSD) technique and reattachment of avulsed skin in treating avulsion injuries of limbs. Methods: A retrospective analysis was done on 25 patients suffering from avulsion injuries of limbs, who were treated with vacuum sealing drainage and reattachment of the avulsed skin. Among the patients, 19 patients were male and 6 patients were female, ranging in age from 21 years to 57 years, with an average of 41 years. After debridement, the patients got reattachment of skin graft with subdermal vascular network or split-thickness skin graft, and the wound surface was covered with poly vinyl sponge. VSD was removed after 7 to 14 days. The color, survival rate and sensory function of the skin were observed after operation. Results: All the wounds infection was controlled with VSD. The skin survival rate was more than 96% in 16 cases,more than 90% in 7 cases,and skin edge of 2 cases had little necrosis but rehabilitated after dress-changing. The reattached skins had almost normal skin color,soft and abrasion resistant,satisfactory sensory function,and no compression ulcer was observed after 4 weeks. Conclusion:VSD combined with graft with subdermal vascular network or split-thickness skin graft helps to promote wound drainage, reattachment of skin, and decrease infection. It is an effective method in treating avulsion injuries of limbs.
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