腹腔镜下切取大网膜游离移植联合植皮术修复下肢大面积难愈性创面

目的探讨腹腔镜辅助下切取大网膜游离移植联合植皮修复下肢大面积难愈性创面的临床效果。方法2013年6月至2018年6月,汉中市中心医院收治的18例下肢皮肤软组织缺损伴多处骨关节、肌腱等深部组织及内置物外露患者,男12例,女6例,年龄15~50岁,平均32.6岁。皮肤软组织缺损面积30 cm×12 cm~53 cm×21 cm。手术分2期进行,一期在腹腔镜辅助下切取大网膜游离移植覆盖创面,术后待大网膜移植成活后,二期以中厚皮片移植修复创面。术后对大网膜及皮片成活情况、并发症、下肢外观和功能等进行观察、随访。结果18例患者手术过程顺利,大网膜切取面积25 cm×10 cm~35 cm×5 cm,术后移植大网膜全部成活,未发生肠粘连、肠扭转及腹膜炎等并发症;皮片切取面积36 cm×8 cm~45 cm×22 cm,16例患者移植皮片完全成活,2例移植皮片局部小面积坏死,经换药后瘢痕愈合。术后随访6~12个月,下肢外观、功能良好,效果满意。结论对下肢大面积软组织缺损,合并多处骨、关节等深部组织及内置物外露创面,行腹腔镜下切取大网膜游离移植联合二期中厚皮片移植修复,创面愈合后外观、功能良好,供区损伤小,术后并发症少。

Clinical research of laparoscopic assisted removal of greater omentum free transplantation combined with skin grafting for the repair of large area refractory wounds

Objective To investigate the clinical effect of laparoscopic assisted removal of greater omentum free transplantation combined with skin grafting for the repair of large area refractory wounds.Methods From June 2013 to June 2018,18 cases of lower extremity skin and soft tissue defects with multiple bone,joint,tendon and internal plants exposure were admitted to Hanzhong Central Hospital,including 12 males and 6 females,aged from 15 to 50 years old,with an average age of 32.6 years old.The area of skin and soft tissue defect:30 cm×12 cm-53 cm×21 cm.The operation was divided into two stages.In the first stage,the greater omentum was acquired with the assist of laparoscope and free transplanted to cover the wound.After the greater omentum free transplantation was confirmed to survive,the split-thickness skin graft was applied for wound repair.Postoperative survival of the greater omentum and skin grafting,complications,appearance and function of lower limbs were observed and followed up.Results The 18 operations were performed successfully,the area of omentum resection was 25 cm×10 cm-35 cm×15 cm,all the greater omentums survived after operation without complications such as intestinal adhesion,volvulus and peritonitis.The area of the skin grafting was 36 cm×8 cm-45 cm×22 cm.16 cases skin grafting survived completely,2 cases skin grafting were necrosis just local small area,and scar healed after dressing change.Postoperative follow-up of 6-12 months showed good appearance and function of lower limbs and satisfactory results.Conclusions For the large area soft tissue defect wound of lower extremity,complicated with multiple deep tissues such as bone,joint and internal materials exposed,the greater omentum free transplantation under laparoscope combined with medium thick skin graft second stage has the advantages of good appearance and function after wound healing,less donor injury and fewer postoperative complications.