人工真皮支架联合灌洗式负压封闭引流在肌腱或骨外露创面修复中的应用

目的探讨人工真皮支架联合灌洗式负压封闭引流修复肌腱或骨外露创面的疗效。 方法选择2018年1月至2020年1月安徽医科大学第一附属医院烧伤科收治的肌腱或骨外露创面39例，其中急性创面26例(外伤10例，烧伤11例，热压伤4例，虫咬伤1例)；慢性创面13例(糖尿病足皮肤溃疡2例，烧伤后期创面7例，瘢痕溃疡4例)。在全身麻醉或神经阻滞下行创面清创，在肌腱或骨外露处植入加强型人工真皮支架，外加负压封闭引流敷料覆盖，术后使用不同冲洗液进行间歇性灌洗，直至组织红润，达到二期植皮手术要求。观察并记录人工真皮支架使用次数，清创后人工真皮支架植入与二期植皮间隔时间和植皮成活情况。 结果39例肌腱或骨外露的急慢性创面经清创后覆盖人工真皮支架，术后经不同冲洗液间歇性灌洗式负压封闭引流治疗，均形成新鲜肉芽组织，二期经刃厚皮片植皮手术，植皮均100%成活，未出现感染等并发症。 结论人工真皮支架植入联合灌洗式负压封闭引流可有效地覆盖外露的肌腱和骨，是急慢性创面合并肌腱、骨外露的有效修复方式之一。

Application of artificial dermis combined with vacuum sealing drainage with instillation in tendon or bone exposure wounds repair

ObjectiveTo investigate the effect of artificial dermis combined with vacuum sealing drainage with instillation in tendon or bone exposure wounds repair. MethodsFrom January 2018 to January 2020, 39 cases of tendon or bone exposed wounds were treated in Department of Burns, First Affiliated Hospital of Anhui Medical University, including 26 cases of acute wounds (10 cases of trauma, 11 cases of burn, 4 cases of thermal pressure injury and 1 case of insect bite) and 13 cases of chronic wounds (2 cases of diabetic foot skin ulcer, 7 cases of later stage of burn, and 4 cases of scar ulcer). After debridement under general anesthesia or nerve block, the exposed tendons or bones were covered with reinforced artificial dermis. After operation, vacuum sealing drainage was performed with different irrigation solutions until the tissues were ruddy and reached the requirements of second stage skin grafting. The use times of artificial dermis, interval time between artificial dermis implantation and secondary skin grafting after debridement and survival of skin grafting were observed and recorded. ResultsThirty-nine cases of acute and chronic wound with tendon or bone exposure were covered with artificial dermis after debridement. Vacuum sealing drainage with different liquid instillation could promote granulation tissue formation after operation. Split-thickness skin graft in second stage survived 100% without infection and other complications. ConclusionArtificial dermis combined with vacuum sealing drainage with instillation can effectively cover the exposed tendon or bone, which is one of the effective repair method for acute and chronic wounds with tendon or bone exposure.