大面积闭合性皮肤潜行剥脱伤的处理

目的　探讨大面积闭合性皮肤潜行剥脱伤 (CIDI)的处理方法。方法　 1987年 9月～ 1999年 10月收治 CIDI共 18例 ,其中大腿 7例 ,小腿 6例 ,骨盆区 5例。面积最小为 15 cm× 12 cm,最大为 38cm× 2 5 cm。急诊时根据不同伤情度采用一种或多种方法处理 :多切口置管负压引流加压包扎 5例 ;非切取式去脂皮片开窗回植 8例 ,游离植皮及岛状肌皮瓣移位各 5例 ;骨与关节损伤固定和修复 11例 ;主干血管修复 4例。结果　非切取式去脂皮片开窗回植 7例全部成活 ,1例 5 cm× 2 cm坏死区植皮愈合。植皮及肌皮瓣移位全部成活 ,骨折均愈合。随访 6个月～ 3年 ,除截肢 1例外 ,余修复肢体外形及功能均接近正常。结论　准确判断伤情度 ,注重 CIDI与深部组织损伤处理并重原则和恰当应用组织修复方法是治疗的关键

MANAGEMENT OF EXTENSIVE CLOSED INTERNAL DEGLOVING INJURY

OBJECTIVE: To study the management of extensive closed internal degloving injury (CIDI). METHODS: From September 1987 to October 1999, 18 cases of CIDI were retrospectively reviewed. Of 18 cases, there were 7 cases in thigh, 6 cases in legs and 5 cases in pelvis, ranging from 15 cm x 12 cm to 38 cm x 25 cm in size. Various managements were adopted according to the severity of the injury, including vacuum drainage and adjuvant compression in 5 cases, regrafting of defatting fenestrated full-thickness skin by non-resection in 8 cases, and skin grafting with transfer of myocutaneous flap in 5 cases. Among them, there were 11 cases of bone and articular fixation or repair, 4 cases of principal vessels repair. All of the cases were evaluated clinically and followed up for 6 months to 3 years. RESULTS: In the 8 cases repaired by regrafting of defatting fenestrated full-thickness skin, only one case of skin necrosis, 5 cm x 2 cm in size, recovered after skin grafting; the others healed well. All of the patients recovered normal life and had normal limbs. CONCLUSION: It's crucial to make a careful assessment about the injury severity of CIDI, to stress on importance of management of both CIDI and deep injury, and to choose proper options after comprehensive assessment of the injury.