超薄皮瓣和全厚皮片联合体成形治疗四肢大面积皮肤撕脱伤

摘要

Objective To discuss the treatment of massive skin avulsion of limbs with ultrathin flaps and fuU-thickness skin grafts. Methods Twenty-one patients with massive skin avulsion of limbs were included in this study.In this group,the area of skin avulsion occupied 2%to 6%of the total body surface. Averaging 3.3%.According to the characteristics and conditions of their wound surfaces.the avulsed skin Wma divided into absolute ischemic zone,partial ischemic zone and abnormal zone.The 3 zones were shaped into a graft complex composed of full-thickness skin zone,junctional zone and ultmthin flap zone respectively.The graft complex was transplanted onto the wound surface.Results In all the patients.90%to 100%of the avulsed skin survived.with an average of 94.1%.There wag no infection.In the 12 cases that had bee followed up for 2 months t0 3 years,the grafted skin showed normal shape,color,texture,sensstion,and function. Conclusions Since the graft complex effectively combines the advantages of both full-thickness flaps and ultmthin flaps and maintains the maximum morphology of the avulsed skin as well.it can improve the survival of avulsed skin.Moreover,the operation is easy and safe.%目的 探讨整合超薄皮瓣和全厚皮片回植治疗四肢大面积皮肤撕脱伤的临床效果.方法 2002年4月至2007年10月应用超皮瓣和全厚皮片联合体成形回植治疗四肢大面积皮肤撕脱伤患者21例.根据皮肤损伤特点和创面情况,将撕脱皮肤自游离缘向蒂部的绝对缺血区、部分缺血区和供血相对正常区分别修剪成皮片区、交界区和超薄皮瓣区,将成形的联合体回植修复创面.结果 本组21例,撕脱皮肤占体表面积2%～6%,平均3.3%,成活皮肤面积占撕脱皮肤90%～100%,平均94.1%,无创面感染,随访12例,一年后回植皮肤质地柔软,无明显挛缩,功能基本恢复.结论 本术式有效地整合超薄皮瓣和全厚皮片移植的优点,最大限度地保存了撕脱皮肤的形态学特点,提高撕脱皮肤成活率,手术简单安全易行.