负压封闭引流术联合游离植皮修复创伤性小腿截肢残端皮肤缺损

目的：观察全厚皮植皮联合负压封闭引流术在治疗小腿截肢残端皮缺损的临床疗效.方法：2009年9月至2012年12月,采用全厚皮植皮联合负压封闭引流术治疗15例小腿截肢残端皮缺损患者,其中男11例,女4例;年龄25～62岁,平均41.5岁;车祸伤10例,重物砸伤5例;左侧9例,右侧6例.小腿毁损伤6例,无保肢价值,急诊行清创、小腿上段截肢并负压吸引术;因小腿感染、坏死转行清创、小腿上段截肢并负压吸引术9例,Ⅱ期均行全厚皮游离移植.小腿残端创面皮肤缺损面积40 cm×20 cm～25 cm×15 cm.结果：所有患者术后获得随访,时间3个月～1年,小腿残端创面移植全厚皮全部成活,均顺利佩戴假肢,行走满意.残端皮肤逐渐增厚,耐磨,无破溃,无疼痛.结论：全厚皮联合负压封闭引流术治疗小腿截肢皮缺损创面,保留了残肢功能长度,植皮成活率高,成活皮瘢痕少,耐磨性好,有利于假肢的佩戴,是一种简单、易行的治疗方法.

Vacuum sealing drainage combined with free skin graft in repairing cutaneous deficiency of traumatic shank amputation stump

Objective：To observe clinical efficacy in treating cutaneous deficiency of traumatic shank amputation stump with full-thickness skin graft combined with vacuum sealing drainage.Methods：From September 2009 to December 2012,15 patients with cutaneous deficiency of traumatic shank amputation stump were treated with full-thickness skin graft combined with vacuum sealing drainage.Among patients,there were 11 males and 4 females with an average age of 41.5 （ranged from 25 to 62） years old.Ten cases were caused by traffic accident and 5 cases were caused by heavy object,9 cases on left and 6 cases on right.Six patients with smashed wound were treated with debridement and amputation,combined with vacuum aspiration inemergency;9 patients caused by infection and necrosis were treated with debridement and amputation,combined with vacuum aspiration,and full-thickness skin graft were performed at stage Ⅱ.The skin defect area of residual limbs ranged from 40 cm× 20 cm to 25 cm×15 cm.Results：All patients were followed up from 3 months to 1 year.Full-thickness skin graft of residual limbs were survived,and obtained satisfactory walking function with prosthetic.Residual skin increased thicken,wearproof without rupture and pain.Conclusion：Full-thickness skin graft combined with vacuum sealing drainage in treating cutaneous deficiency of traumatic shank amputation stump could reserve the length of residual limbs,increase survival rate of skin graft with less scar of survival skin,get good wearability and it is conducive to prosthetic wear.It is a simple and easy treatment method.