皮肤软组织深度损伤的外科治疗

目的 探讨皮肤软组织深度损伤的治疗方法.方法 2006年7月-2008年1月,笔者单位共收治皮肤软组织深度损伤患者56例,其中火焰烧伤23例、电击伤17例、热压伤7例、撕脱伤6例,其他原因(交通伤、挤压伤、皮肤软组织感染)致伤3例.共应用各类皮瓣65个修复创面,其中局部皮瓣21个、远位带蒂皮瓣18个、游离皮瓣26个,皮瓣面积1.5 cm×1.0 cm～39.0 cm×23.0 cm.结果 60个皮瓣完全成活,3个部分坏死,2个完全坏死.局部皮瓣成活率为95.2%,远位带蒂皮瓣成活率为88.9%,游离皮瓣成活率为92.3%.各类皮瓣成活率比较,差异无统计学意义(P>0.05).结论 皮瓣移植仍然是修复深度皮肤软组织损伤的有效方法,在保证成活率的前提下,采用游离皮瓣进行修复具有一定的优越性.

Surgical therapy for massive deep skin and soft tissue injuries

Objective To explore the methods of repair of massive deep skin and soft tissue inju-ries. Methods Fifty-six patients with deep skin and soft tissue injuries were hospitalized from July 2006 to January 2008. Among them, 23 cases were caused by burn, 17 cases by electric injury, 7 cases by hot crush injury, 6 cases by avulsion injury, and 3 cases due to other reasons (including traffic accident, crush injury, soft tissue infection respectively). Sixty-five skin flaps were raised to repair and reconstruct the in-jured tissues, including 21 local flaps, 18 distant pedicled skin flaps, and 26 free skin flaps. The area of skin flaps ranged from 1.5 cm×1.0 cm to 39.0 cm × 23.0 cm. Results Sixty skin flaps survived com-pletely, partial necrosis occurred in 3 flaps, and complete necrosis in 2 flaps. There was no obvious differ-ence in average survival rate among local skin flaps (95.2%) , distant pedicled skin flaps (88.8%), and free skin flaps (92.3% , P >0.05). Conclusions Skin flap transposition can be still considered as the major effective method in repair of massive deep skin and soft tissue injury. On the premises of high survival rate, free skin flap transposition can be considered as the first choice.