老年患者下肢大面积皮肤撕脱伤急诊修复方法与疗效

摘要

Objective To evaluate the emergency repair method and its effect for treatment of extensive avulsion injury of the lower extremity in the elderly patients.Methods From May 2008 to February 2015,11 patients aged over 60 years sustaining large avulsion injury (across the knee or ankle joint) of the lower limb in traffic crushes were treated by emergency debridement and one-stage repair with the procedures of autologous skin replantation,arteriovenous anastomosis and vacuum sealing drainage (VSD).Two patients sustained injury to both lower limbs,and nine patients sustained a unilateral injury.Effect of wound repair was evaluated with skin flap survival area.Active and passive motility of the knee and ankle were recorded at postoperative 24 h.Results One patient with multiple fracture and extensive muscular inactivity due to severe crush injury to the lower limbs had poor blood supply after the replantation and was amputated at postoperative 24 h.The remaining ten patients with large skin avulsion showed 90％ of the avulsed skin survived after operation.At the follow-up of 3-24 months,the ten patients showed no obvious pigmentation or scar tissue,were satisfied with the function recovery in knee (106°-110° in flexion and 0°-5°in extension) and ankle joint (15°-20°in dorsiflexion and 30°-35° in plantar flexion),and could walk freely,including excellence outcomes in 3 patients and good outcomes in 6 patients.Conclusion The emergency repair methods including autologous skin replantation,arteriovenous anastomosis and VSD combined with one-stage in situ repair can attain satisfactory clinical effect.%目的 探讨老年患者下肢大面积皮肤撕脱伤急诊原位修复的方法与临床疗效.方法 2008年5月-2015年2月共收治60岁以上由交通伤所致下肢大面积(跨膝/踝关节)撕脱伤患者11例,其中双下肢2例,单肢体9例,均给予急诊清创后行自体皮片回植法、动静脉吻合术及持续负压封闭引流(VSD)技术三种方法结合Ⅰ期修复.通过观察受区皮肤成活面积评估创面修复效果,评价伤肢膝关节和踝关节术后24个月的主动及被动活动功能. 结果 l例双下肢因碾压严重,合并多发骨折,肌肉广泛失活,皮片回植后,肢体血运差,术后24 h给予截肢.另10例为下肢皮肤大面积剥离撕脱,术后90％以上撕脱皮肤成活,经3～ 24个月随访,患肢外观无明显色素沉着或瘢痕组织.患肢膝关节屈曲106°～110°、过伸0°～5°.踝关节稳定,背屈15°～ 20°、跖屈30°～35°,患肢行走膝、踝关节未见明显受限,优3例,良6例,患者满意. 结论 急诊自体皮片回植、动脉静脉吻合术及VSD技术相结合进行Ⅰ期原位修复老年大面积皮肤撕脱伤,可获得满意的临床疗效.