减张缝合负压封闭引流治疗跟骨骨折术后皮肤坏死

目的：探讨采用减张缝合负压封闭引流治疗跟骨骨折术后皮肤坏死的临床效果。方法：2009年8月至2012年12月,我们治疗8例新鲜跟骨骨折采用外侧L型切口术后皮肤坏死患者,其中男6例,女2例,年龄23~55岁,平均37岁。骨折分型：SandersⅡ型3例,SandersⅢ型5例。内固定术后5~10 d（平均7 d）出现皮肤坏死,坏死范围长2~8 cm,宽1~3 cm。其中2例继发切口感染。采用清创水平褥式减张缝合持续负压封闭引流治疗,7 d后拆除生物敷料,每隔2~3 d清洁换药,术后随访1年。结果：本组8例患者切口于术后14~21 d愈合,平均18 d,2例切口感染患者拆除生物敷料后再次行细菌培养阴性,无深部感染和骨髓炎发生。随访1年所有皮肤切口愈合部位无明显瘢痕增生及破溃,患者负重及行走均无困难。结论：对跟骨骨折术后皮肤坏死宽度小于3 cm者,通过减张缝合负压封闭引流技术可使创面愈合。

Tension suture with vacuum sealing drainage in treatment of skin necrosis after open reduction with internal fixation of calcaneal fracture

Objective： in treating skin necrosis To explore the effectiveness of tension suture with vacuum after open reduction with internal fixation （ORIF） of sealing drainage （VSD） method calcaneal fracture. Methods ： Between August 2009 to December 2012, 8 cases of skin necrosis after ORIF of calcaneal fracture using lateral L- shaped incision were treated, including 3 cases of Sanders type Ⅱ and 5 cases of Sanders type Ⅲ. There were 6 males and 2 females with an average age of 37 （23-55） years. All fractures were close fractures and were treated by ORIF with plate. Skin necrosis occurred at 5-10 days （mean, 7 days） after fixation. 8 cases of necrotic area length 2-8 cm, width of 1-3 cm. 2 cases of secondary wound infection. Debridement using horizontal mattress suture continuous vacuum sealing drainage treatment, 7 days after removal of biological dressings, every 2 to 3 days clean dressing, and followed up for 1 year. Results： All 8 patients incision healed 14 to 21 days, an average of 18 days, two cases of wound infection after removal of biological dressings bacterial culture negative, no deep infection and osteomyelitis, no hypertrophic scar and skin ulceration, and no patient had difficulty in weight-bearing and walking. Conclusion： Skin necrosis width of less than 3 cm after ORIF of calcaneal fracture can be cured by tension suture with VSD method.