大面积皮肤撕脱伤32例治疗分析

目的：观察大面积皮肤撕脱伤的治疗效果.方法：32例大面积撕脱伤患者,在早期抗休克、治疗脏器合并伤基础上,撕脱面积较小、创基血运好者直接原位缝合;挫伤严重、已游离的大面积撕脱皮肤组织切取后,反取成大张中厚皮片,原位缝合于创面.骨质裸露的创面,以腓肠肌肌瓣、趾长屈肌肌瓣、胫前肌肌瓣等转移覆盖骨,再植以反取的大张中厚皮片.术后第2天开始行高压氧治疗,疗程1周.结果：32例患者中12例植皮一次成活;17例移植皮片部分坏死,肉芽创面经换药后愈合;3例因回植皮片挫伤严重而片状坏死,后期肉芽创面植皮后愈合.对17例瘢痕增生及粘连较重者行肢体功能锻炼,并随访2年,功能基本恢复正常.结论：大面积皮肤撕脱伤伤情严重,需首先处理危及生命的颅脑损伤和休克,同时彻底清创,封闭创面,裸露的骨面用邻位健康的肌瓣覆盖后再植以大张游离皮片,治疗效果满意.

Analysis on treatment for large-area avulsion injury of skin in 32 cases

Objective： To observe the therapeutic effect of large-area avulsion injury of skin. Methods： After successful treatment of shock and combined organ injuries, extensive avulsion of skin in 32 patients was treated as follows. Avulsions of small area of skin with good blood supported were directly sutured; large area avulsion with serious contusion of the avulsed subcutaneous tissue were transformed into split thickness skin graft, and then it was grafted on the open wound. When the underlying bone was exposed, the wound was first covered with gastrocnemius muscle flap, flexor digitorum longus muscle flap or anterior tibial muscle flap at first, and finally covered with split thickness skin graft. All patients were treated with hyperbaric oxygen （HBO） on the second postoperation day, for a course of 7 days. Results： In 32 cases who were skin grafted, 12 wounds healed well, in 17 pa tients, the wounds healed after dressing changes, in 3 cases there was necrosis of skin after operation, and the granulation wounds were finally repaired by second skin grafting. Within 2 years of follow-up, 17 patients who de- veloped hyperplasia of scar and adhesion were treated with active functional exercise, with a final result of recovery of function of the limbs. Conclusion： Large-area skin avulsion injury is a serious injury. In these patients, serious craniocerebral injury and shock should be treated at first, then the wound should be thoroughly debrided. Wounds with exposed bone should be covered by healthy local muscle flap and large free skin graft. The treatment result is satisfactory.