腹部皮瓣和植皮联合负压封闭引流修复手部大面积皮肤脱套伤及缺损

目的 探讨大面积手部皮肤脱套伤并缺损的修复方式.方法 2005年6月-2010年1月,应用腹部皮瓣包埋和游离中厚皮片植皮结合负压封闭引流(vacuum sealing drainage,VSD)技术治疗手部大面积皮肤脱套伤合并缺损12例,其中男8例,女4例;年龄21~56岁,平均34岁.机器绞伤9例,车祸伤3例.所有损...

Reparation of Large-area Hand Avulsed Wound and Soft Tissue Defects with Abdominal Skin Flaps and Skin Grafting Combined with Vacuum Sealing Drainage Technique

Objective To investigate the ideal repair method for large-area hand avulsed wound and soft tissue defects.Methods From June 2005 to January 2010,12 patients with large-area hand avulsed wound and soft tissue defects were repaired with abdominal skin flaps and skin grafting combined with vacuum sealing drainage technique.The patients included 8 males and 4 females with their age ranged from 21 to 56 years averaging at 34 years.The causes of injury were machine twist injury in 9 cases and road accident injury in 3 cases.All the injuries combined with exposure of tendon,joint or bone.The area of defects ranged from 8 cm×9 cm to 18 cm×25 cm.The time between injury and operation was 4 to 17 hours averaging at 6.5 hours.The palm of hand and fingers were repaired by abdominal pedicle skin flaps,and the dorsum of hand and wrist were repaired by skin grafting combined with vacuum sealing drainage.About 3 weeks later,all pedicles of the abdominal flaps were cut off and flaps plasty were carried out.Results All patients were followed up from 6 to 42 months with an average period of 17 months.All of the flaps and skin grafts survived.Only 6 patients had distal edge partial necrosis,and all of them healed after a short time of dressing changes or second-stage skin grafting.All skin grafts of the donor sites survived and all the wounds healed by first intention.All the injured hands recovered well to their original shape and function except partial bad skin sensation.The sense of two-point discrimination was from 6 mm to 13 mm with an average distance of 9.5 mm.The active motion of metacarpophalangeal joints averaged at 60°,and the interphalangeal articulations averaged at 30°.Conclusion Abdominal skin flaps and skin grafting combined with vacuum sealing drainage technique can be used to repair large-area hand avulsed wound and soft tissue defects,and it is practical,safe and simple