免打结可吸收线减张缝合伤口在闭合四肢创面中的应用

目的：探讨免打结可吸收线减张缝合在闭合四肢创面中的疗效。方法：选择2012-02-2013-12我院手外科收治的37例四肢急慢性皮肤缺损患者,创面均使用免打结可吸收线进行减张缝合,使创面一次闭合。男25例,女12例;年龄4～72岁,平均（34±2）岁。车祸伤19例,机器损伤10例,重物砸伤4例,感染3例,刀砍伤1例;急性创面26例,慢性创面11例。观察伤口愈合过程和愈合时间,术后半年对患者进行主观和客观评价。评价方法包括视觉模拟评分和Vancouver疤痕评分。结果：术后随访6～19个月,平均10个月。35例创面一次减张缝合后愈合,拆线时间为15～25d,平均20d;2例二次手术后愈合。减张缝合的愈合率是97.3%,一次减张缝合的愈合率是94.6%,感染率是5.4%。疤痕疼痛VAS是0～5分,平均1.7分,疤痕外观VAS是0～8分,平均2.9分。Vancouver疤痕评价得分是1～8分,平均2.4分。结论：免打结可吸收线减张缝合可以直接闭合创面,显著降低术后皮肤坏死、二期缝合、游离植皮和皮瓣转移的可能,减少手术次数,缩短病程。

The use of the bidirectional,barbed,absorbable suture in the closure of extremity wound

Objective：To study the effect of the bidirectional,barbed,absorbable suture in the closure of extremity wound.Method：37patients（25males and 12females）suffering acute or chronic injury in extremity were treated with no-tension suture with the bidirectional,barbed,absorbable thread.The extremity wound was closed in one-stage operation.Their age ranged from 4to 72,with an average of 34.The causes of the injury varied.There were traffic accidence in 19 cases,machine crush injury in 10 cases,heavy crush injury in 4cases,infection in 3cases and knife incision in 1case.The acute wounds were 26 cases and the chronic wounds were 11 cases.The wound healing progress was observed.Subjective and objective assessment on the wound were done at the sixth month post-operation,including Visual Analogue Score and Vancouver Scar Scale.Result：All the patients were followed up for 6～19months after operation,with an average of 10 months.The wound healed after one time suture in 35 cases,and the sutures were taken out in 15～25days,with average of 20 days.In 2cases the wound needed a second operation.All the wounds healed perfectly.The direct healing rate reached 97.3%,the rate of one-time closing was 94.6%,and the infection rate was 5.4%.the pain average scare was 1.7（0～5）,the cosmetic average score was 2.9（0～8）,and Vancouver Scar average scare was 2.4（1～8）.Conclusion：No-tension suture with the bidirectional,barbed,absorbable thread can close wounds one time.It significantly decreased the possibility of skin necrosis,secondary suture,skin graft and flap transfer.It also reduced the time of operation and shortened the disease course.