应用皮肤牵张带延期闭合骨筋膜室减张切口

目的观察应用皮肤牵张带延期直接缝合骨筋膜室减张切口的效果。方法因骨筋膜室综合征而行切开减压术导致皮肤缺损患者 21例，年龄 7～ 36岁，小腿皮肤缺损 17例、前臂皮肤缺损 3例、足部皮肤缺损 1例。缺损区最小 5 cm× 15 cm，最大 11 cm× 28 cm，合并骨外露和肌腱外露者各 1例。于骨筋膜室切开减压后第 4～ 7 d放置皮肤牵张带，此后 3～ 7 d天待牵拉至两侧皮缘靠近时延期缝合伤口， 2周后拆线。结果 21例患者， 20例伤口一期愈合，形成线状瘢痕； 1例在放置皮肤牵张带之前伤口红肿，有较多分泌物，置皮肤牵张带 2 d后分泌物仍较多，故拆除 3根硅胶带，伤口引流，遗留 2 cm× 5 cm创面，经换药、小块游离皮片植皮后伤口愈合。 2例合并骨外露和肌腱外露者伤口愈合良好。随访 3～ 15个月，患肢远端关节活动自如，无肌肉挛缩现象。结论急性骨筋膜室综合征切开减压后，使用皮肤牵张带延期缝合伤口，安全、有效。其优点 :(1)操作方法简便、快速，病程短，费用相对较低； (2)无需游离皮片植皮，愈合后形成线状瘢痕，局部皮肤质量较好，对美观影响小； (3)同样适用于伴骨外露和肌腱外露者，可避免施行皮瓣转移覆盖手术。

Secondary wound closure following fasciotomy with the external tissue extender

Objective To observe the effects of the external tissue extender (ETE) for secondary wound closure following fasciotomy after acute compartment syndrome. Methods Twenty one cases (age, 7－ 36 years old) following fasciotomy were treated with the ETE for secondary wound closure. The wounds occurred in the leg in 17 cases, the forearm in 3 and the foot in 1. The largest wound measured 11 cm× 28 cm, the smallest 5 cm× 15 cm. One case was accompanied with exposure of the tibia, and the other with tendon. Placement of the ETE was carried out at 4－ 7 days following fasciotomy. The secondary wound closure was done when the distance between the wound edges was smaller than 1 cm, usually at 3－ 7 days after the ETE procedure. Results The wounds healed in 20 cases without skin grafting, forming a line like scar. In one case, part of the ETE had to be removed because of wound infection, and small skin grafting was done later. The wounds also healed well in those two cases with the exposure of the tibia and tendon after using the ETE. With 3－ 15 months follow up, distant joints adjacent to the wounds showed good range of motion, without muscular contracture. Conclusion It is safe to use the ETE for secondary wound closure following fasciotomy after acute compartment syndrome. Wound closure with the ETE shows following advantages: 1) It is a simple, convenient and fast speed procedure, with a short stay of hospital and relatively low cost. 2) Skin graft is not needed, forming a line like scar after healing. It shows good skin quality and cosmetic appearance. 3) The procedure is also suitable for those cases with exposure of bone or tendon.