联合负压封闭吸引技术治疗手部皮肤撕脱伤

目的：探讨负压封闭引流技术（Vacaum staling drainage,VSD）治疗手部皮肤撕脱伤的临床效果。方法：对近3年来本院收治的手部皮肤撕脱伤的40例患者采用筛孔状全厚皮片移植法修复,皮片表面用聚乙烯酒精水化海藻盐泡沫（商品名＂维斯第＂）覆盖封闭,24h不间断负压吸引（维持负压在-40～-60kPa）。结果：平均使用VSD7d,37例皮片全部存活,创面愈合,3例皮片存活90%～97%,经换药后,创面愈合;与对照组比较,在患手指体肿胀程度、患手总主动活动度（total active movement,TAM）、患者重返工作岗位时间等方面差异均有统计学意义（P〈0.05）。结论：筛孔状全厚皮片移植法原位修复结合VSD处理手部皮肤撕脱伤能在Ⅰ期关闭创面的同时更好地进行创面引流,促进创面良好贴附,有利于皮片存活,可促进患手局部静脉及淋巴回流,是治疗手部皮肤撕脱伤较好地处理方法。

Treatment of avulsion injury of skin in hands by reattachment of skin combined with vacuum sealing drainage

Objective： To investigat the treatment effects of reattachment of skin combined with vacuum sealing drainage （VSD） on avulsion injury of skin of hands. Metbods： 40 cases of treated by reattachment of with sieve-pore full-thickness skin grafts in recent 3 years, the wound surface was filled with polyethylene alcohol hydration seaweed salt bubble （vacuscal） continuous negative pressure drainage was taken for 24 h （maintain the negative pressure between-40 to-60 kPa）. Results： The average time of VSD was 7 days, 37 cases recovered completely, the flap survival rate in 3 cases was reattaching 90%～97%, after several dressing changes, the wound healing; Compared with control group, the swelling degree of fingers, total active movement of hands, the time of patients return to work were statistically significant difference （ P0.05）. Conclusion： Sieve hole shape the thick skin of in situ VSD repair combining with transplants hand skin avulsed injury in Ⅰ period can shut down the wound and better wound drainage, promote wound to good attached with, be helpful for leather piece of live, and can promote local venous and lymphatic with hand backflow, is the treatment hand skin avulsed injury better processing method.