负压封闭引流技术联合人工真皮治疗足踝部皮肤软组织缺损

目的 :探讨负压封闭引流技术(VSD)联合人工真皮治疗足踝部皮肤软组织缺损的临床治疗效果。方法 :自2011年1月至2013年12月间收治15例足踝部皮肤软组织缺损患者,其中男10例,女5例;年龄3~55岁,平均32.5岁;车祸伤8例,机器绞伤2例,碾压伤5例;单纯的肌肉软组织外露8例,肌腱外露2例,骨外露5例。清创后VSD覆盖创面并持续负压引,Ⅱ期待创面肉芽组织生长良好后用人工真皮覆盖创面,再次VSD覆盖创面并负压吸引,7~14 d后去除负压封闭引流,人工真皮上方移植游离皮片,无菌纱布加压包扎。结果 :所有患者获得随访,时间3~14个月,平均6.5个月。15例患者植皮片全部存活,人工真皮移植后植皮间隔时间为7~14 d,平均9.5 d。术后移植皮肤未见明显瘢痕增生及挛缩,无明显色素沉着,外观及功能恢复满意。结论:人工真皮植入后再行植皮传统的方法需2~3周,负压封闭引流技术联合人工真皮治疗足踝部皮肤软组织缺损,操作简单,明显缩短Ⅱ期植皮时间,无须皮瓣修复,供皮区损伤少,创面愈合质量高,临床效果满意。

Clinical research of vacuum-sealing drainage combined with artificial dermis for the treatment of ankle and foot soft tissue defects

Objective: To investigate the effect of vacuum-sealing drainage(VSD) combined with artificial dermis for treatment of the ankle and foot soft tissue defects. Methods: A total of 15 patients with skin and soft tissue defect of ankle and foot were treated from January 2011 to December 2013,including 10 males and 5 females,with an average age of 32.5 years old ranging from 3 to 55 years old,involving 8 cases by traffic accident,2 cases by machine accident,5 cases by crush injury;8 cases with soft tissue exposure,2 cases with tendor exposure,5 cases with bone exposure. VSD was used to cover the wounds and continuous negative pressure drainage after debridement,the wounds covered with artificial dermis after the second granulation tissue grew well,again VSD was used to cover the wounds and negative pressure suction was applied,after 7 to 14 days negative pressure closed drainage was removed,free skin graft was transplanted above the artificial dermis,sterile gauze was used to compression bandage. Results: All cases were followed up for 3 to 14 months with an average of 6.5 months. Skin graft of 15 of patients survived after transplantation,artificial dermis graft interval was 7 to 14 days with an average of 9.5 days. There was no obvious scar hyperplasia and contracture,no obvious pigmentation,appearance and functional recovery. Conclusion: After the implantation of artificial dermis and traditional skin graft method need for 2 to 3 weeks,vacuum sealing drainage technique combined with artificial dermis in treatment of soft tissue defect of foot and ankle skin has advantages of simple operation,significantly shorten the time of the second phase of the skin,without flap to repair,little injury to donor skin area,wound healing quality high,clinical effect of satisfaction.