交通事故致下肢大面积皮肤撕脱伤的治疗

目的 探讨交通事故致下肢大面积皮肤撕脱伤的治疗。方法 回顾分析我科收治的30例（34处）交通事故致下肢大面积皮肤撕脱伤的诊治。本组8例截肢；7例皮肤原位缝合；2例中厚皮片游离植皮；10例（12处）去脂全厚皮片开窗回植；1例皮下置管引流，加压包扎；1例穿刺抽吸加压包扎；1例I期腓肠神经营养逆行岛状皮瓣转移；1例自体表皮细胞复合同种异体皮肤覆盖创面。同时处理合并损伤。结果 平均随访21个月。本组1期全部/大部皮片和皮瓣成活共23处，成功率67.6%。4例大面积皮片坏死，Ⅱ期行局部皮瓣或肌皮瓣转移，全厚皮片、皮瓣或肌皮瓣成活后功能良好。结论 准确判断伤情和正确选用创面修复方法是确保治疗成功的关键。

Management of extensive avulsed injuries in lower limbs caused by traffic accidents

Objective To study the management of extensive avulsed injuries in the lower limbs caused by traffic accidents. Methods The treatment of 30 patients(34 sites) were retrospectively reviewed. Amputation were performed in 8 cases,sewn-back in 7 cases,split thickness skin regrafting in 2 cases,defatting fenestrated full thickness skin regrafting in 10 cases,vacuum drainage and adjuvant compression in 1 cases,puncture and adjuvant compression in 1 case,primary fasciocutaneous flap transfer in 1 case,and autogenic epidermal cells transfer combined with allogeneic skin grafting in 1 case. Results The average follow-up was 21 months. Twenty-three sites ((67.6%)) healed well. Four cases complicated with extensive skin necrosis were secondarily reconstructed with local skin flaps and myocutaneous flaps transfer. The function of regrafting full thickness skin,skin flaps and myocutaneous flaps is fine. Conclusion Evaluation of the severity of the injury,choose the correct repair are the key points for successful treatment.