皮瓣移植结合封闭式负压引流修复下肢皮肤及软组织缺损

背景：各种创伤引起的下肢皮肤及软组织缺损十分常见,常伴有严重的血运破坏和创面感染,患肢感染率高,不易愈合。目的：系统回顾关于下肢皮肤及软组织感染性缺损治疗的相关文献,结合华中科技大学同济医学院附属普爱医院治疗的下肢皮肤及软组织感染性缺损23例患者治疗效果,探讨皮瓣移植结合封闭式负压引流治疗感染性下肢皮肤及软组织缺损的适应症、方法及临床应用价值。方法：文章选取2004年8月至2011年11月在华中科技大学同济医学院附属普爱医院治疗的下肢皮肤及软组织感染性缺损患者共23例,男15例,女8例;年龄17-56岁,平均31.4岁。对23例下肢皮肤及软组织感染性缺损患者采用皮瓣移植结合负压封闭引流治疗,随访时间为4-15个月,平均7.3个月,观察临床效果。同时检索下肢皮肤及软组织感染性缺损治疗的相关文献,找出治疗对象相似、疗效评价标准相同的病例进行比较。结果与结论：23例下肢皮肤及软组织感染性缺损患者伤口感染菌中革兰阳性菌占52.2%,革兰阴性菌占47.8%,多重耐药菌占43.5%,应用封闭式负压吸引技术处理后,创面感染得到有效的控制,创面肉芽组织生长良好,通过皮瓣移植修复创面均痊愈。结果显示,皮瓣移植结合封闭式负压引流治疗感染性下肢皮肤及软组织缺损,可缩短创面愈合时间。

Flap transplantation combined with closed negative pressure drainage for repairing lower extremity skin and soft tissue defects

BACKGROUND： Various traumas caused lower extremity skin and soft tissue defects are very common and often accompanied by severe blood supply damage and wound infection with high infection rate and not easy to heal. OBJECTIVE： To systematic review the literatures on the treatment of lower extremity skin and soft tissue infections defect, and to explore the indications, methods and clinical significance of flap transplantation combined with closed negative pressure drainage for repairing lower extremity skin and soft tissue defects combined with the treatment results of 23 patients with lower extremity skin and soft tissue defects treated in Pu Ai Hospital of Wuhan, Tongji Medical College of Huazhong University of Science and Technology. METHODS： Twenty-three patients with lower extremity skin and soft tissue defects treated in Pu Ai Hospital of Wuhan, Tongji Medical College of Huazhong University of Science and Technology were selected from August 2004 to November 2011, 15 cases in male and 8 cases in female; the age was 17-56 years, average 31.4 years. All the patients were treated with flap transplantation combined with closed negative pressure drainage. The follow-up time was 4-15 months, average 7.3 months, and then the clinical effects were observed. The relative literatures on the lower extremity skin and soft tissue defects were screened and found the similar treatment objects and the same evaluation criteria for comparison. RESULTS AND CONCLUSION： Among the 23 patients with lower extremity skin and soft tissue defects, the wound infections bacteria including Gram-positive bacteria accounted for 52.2%, Gram-negative bacteria accounted for 47.8% and multi-resistant bacteria accounted for 43.5%. After treated with closed negative pressure drainage, the wound infection was effectively controlled and the growth of wound granulation tissue was good. The wound was healed afterflap transplantation. The results showed that flap transplantation combined with closed negative pressure drainage for repairing lower extremity skin and soft tissue defects could shorten wound healing time.