医用胶原蛋白海绵及负压封闭引流联合自体刃厚皮复合移植在足部毁损伤难愈性创面中的应用

目的观察医用胶原蛋白海绵及负压封闭引流(VSD)联合自体刃厚皮复合移植修复足部毁损伤难愈性创面的效果。方法选取2017年1月至2019年10月海南省人民医院烧伤与皮肤修复外科收治的足部毁损伤难愈性创面患者18例,其中合并足背肌腱外露12例,跖骨骨外露6例。创面清创后,予医用胶原蛋白海绵覆盖肌腱外露、骨外露创面,并安装VSD装置,待创面覆盖肉芽组织后,再给予自体刃厚皮移植修复创面。记录治疗时间、外露肌腱或骨质坏死率、皮片成活率,术后随访6个月,以Maryland足部功能评分标准评估外观及功能。结果18例患者足部均得以保存,外露的肌腱和骨质均保持活性,皮片成活率85%~95%,平均(90±5)%。残余创面给予间断换药治疗后全部愈合,治疗时长14.0~45.0 d,平均(29.5±15.5)d。出院后6个月复诊以Maryland足部功能评分标准评估足部功能,优3例,良4例,中6例,差5例。结论医用胶原蛋白海绵及VSD在促进肌腱、骨质外露创面肉芽组织生长的同时可保留外露的肌腱及骨组织活性,联合自体刃厚皮移植,能较好地修复足部毁损伤难愈性创面。

Application of medical collagen sponge and vacuum sealing drainage combined with autologous epidermal skin graft in the refractory wound of foot destructive injury

Objective To observe the effect of medical collagen sponge and vacuum sealing drainage(VSD)combined with autologous epidermal skin graft in the treament of refractory wound of foot destructive injury.Methods From January 2017 to October 2019,18 patients with refractory wounds after foot destructive injury were treated in Department of Burns and Wound Repair Surgery,Hainan Provincial People′s Hospital,including 12 cases with dorsal tendon of foot exposure,6 cases with metatarsal bone exposure.After debridement,collagen sponge was given to cover the tendon exposed and bone exposed wound,and VSD device was installed.When granulation tissue cover the wound,the autologous epidermal skin was grafted on.The duration of treatment,the rate of necrosis of exposed tendon or bone and the survival rate of epidermal skin were recorded.All patients were followed up for 6 months.The appearance and function of patients were evaluated after the treatment.Results The feet of 18 patients were preserved.The exposed tendons and bones remained activity.Survival rate of epidermal skin was 85%-95%,average(90±5)%.All residual wounds healed after intermittent dressing change.The duration of treatment were 14.0-45.0 d,average(29.5±15.5)d.The foot function was assessed by Maryland foot function score in 6th month after discharge,excellent in 3 cases,good in 4 cases,moderate in 6 cases and poor in 5 cases.Conclusion Medical collagen sponge and VSD can promote the growth of granulation tissue in the wound with exposed tendon or bone,and meanwhile retentive their activity,which can repair the refractory wound of foot destructive injury combined with autologous epidermal skin graft.