带蒂胸脐皮瓣加部分皮片回植治疗前臂大面积皮肤脱套伤

目的探讨应用带蒂胸脐皮瓣及部分皮片回植治疗前臂大面积皮肤脱套伤的临床疗效。方法对2009年2月-2012年8月收治的10例前臂大面积皮肤脱套伤，根据脱套皮肤损伤情况，采用带蒂胸脐皮瓣修复腕或肘关节，同时根据伤情修剪部分脱套皮肤成中厚皮片、含真皮下血管网皮片或吻合静脉，作原位回植修复其余创面。所有皮瓣均于术后3～4周断蒂。结果10例皮瓣全部成活，2例回植皮片成活面积100％，5例回植皮片成活95％。2例回植皮片成活90％，1例回植皮片成活80％，遗留创面经二期植皮或换药全部愈合。术后随访3～12个月，皮瓣外形较好，质地柔软，回植皮肤无溃疡；腕、肘关节功能恢复良好。结论带蒂胸脐皮瓣加部分皮片回植治疗前臂大面积皮肤脱套伤，有助于肘、腕功能恢复；彻底清创、对脱套皮肤的伤情评估、尽量削薄及静脉修复是提高回植皮肤成活率的关键。

Treatment of large-area forearm degloving injury by pedicled thoracoumbilicus flap combined with autogenous skin graft

Objective To discuss the clinical effect of treating large-area forearm degloving injury by pedicled thoracoumbilicus flap combined with autogenous skin graft. Methods 10 cases with large-area upper limps degloving injury were treated between February 2009 and August 2012. Elbow or wrist wound were repaired with pedicled thoracoumbilicus flap. According to injury characteristics, other wound were treated by venous anastomosis or repaired with subdermal vascular network skin grafts or split- thickness skin grafts. About 3 to 4 weeks later, all pedicled thoracoum-bilicus flap were cut off. Results All pedicled thoracoumbilicus flap survived. In 10 cases, skin graft survival area was 100% in 2 cases, 5 cases was 95%, 2 cases was 90% and 1 cases was 80%. All necrotic wound healed after changing dressing or skin graft. Average follow-up was 6.5 months, ranging from 3 to 12 months. The flaps had soft texture, good appearance and no obvious ulcer in skin grafts region. Elbow and wrist functions in all cases were satisfactory. Conclusion It help to improve elbow and wrist functions for treating large-area forearm degloving injury by pedicled thoracoumbilicus flap combined with autogenous skin graft. The key to improve the survival rate of skin grafts is to debride completly, evalute for degloving injury characteristics, cut thin skin and anastomose vein as far as possible.