创面菱形分布切开联合负压封闭引流技术对毒蛇咬伤的临床价值

目的 探讨创面菱形分布切开联合负压封闭引流技术（VSD）治疗毒蛇咬伤的临床价值。方法 选取2017年4月—2018年11月雅安市人民医院就诊的毒蛇咬伤指（趾）患者168例。其中，2017年4月—2017年11月76例患者（A组）采取回顾性分析；2018年4月—2018年11月92例患者采取前瞻性研究。92例患者中采取单纯创面菱形分布减压切开暴露引流55例（B组），创面菱形分布减压切开联合VSD 37例（C组），记录并对比患肢肿胀消退时间、远端局部溃烂坏死、关节功能障碍遗留、创面感染及截指（趾）情况。结果 3组患者性别、年龄、伤肢肿胀程度及严重程度比较，差异无统计学意义（P?>0.05）。3组患者住院时间、肿胀消退时间、创面感染、皮瓣坏死及功能障碍比较，差异有统计学意义（P?<0.05）。A组住院时间、肿胀消退时间长于B、C组（P?<0.05）。A组出现皮瓣坏死与残留功能障碍例数与B、C组（P?<0.05）；C组在彻底清创以后，未预防性使用抗菌药物，在创面感染控制上优于B组（P?<0.05）。结论 菱形小切口皮瓣切开，能最大限度地解除组织肿胀后皮肤张力，缓解远端供血不足导致溃烂、坏死、截指（趾），挽救缺血性肌挛缩损害后的关节功能；联合VSD负压吸引技术更利于创面管理，缩短肿胀的消退时间。

Clinical observation of rhombotomy combined with VSD negative pressure suction for venomous snake bite wound

Objective To explore the protective treatment of swollen snake bite swollen wounds, to prevent the occurrence of skin ulceration and ischemic muscle contracture, and to save limbs and functions. Methods A total of 168 cases of snake bites (toes) from April 2017 to November 2018 were selected, including 76 cases from April to November 2017 (group A, n?=?76) were retrospectively analyzed, and the other 92 patients from April to November 2018 were prospectively studied, treated with simple wound diamond-shaped decompression and open drainage (group B, n?=?55) and wound diamond-shaped decompression and incision VSD vacuum suction drainage (group C. n?=?37). The swelling time of the affected limb, local ulceration and necrosis at the distal end, residual dysfunction of the joint, wound infection and finger (toe) were recorded and compared. Results There were no significant differences in gender, age, swelling degree and classification of the three groups (P?>?0.05). There were significant differences in hospitalization time, swelling regression time, wound infection, flap necrosis and dysfunction among 3 groups (P?