多部位撕脱伤的整形修复与探讨

目的 探讨不同部位皮肤软组织撕脱伤的处理及撕脱皮瓣保留再利用与舍弃条件的判定.方法 回顾性总结并分析58例撕脱伤创面的整形修复,依据撕脱面积大小、形态,选择创面最佳修复方法,即:①撕脱皮肤“反鼓”制成中厚皮片移植;②创面清创异体皮移植,Ⅱ期自体皮置换移植;③局部皮瓣移植覆盖裸露的神经、血管、骨关节及睾丸,其它创面自体皮片移植;④保留部分撕脱皮肤的皮瓣原位移植;⑤扩张后皮瓣移植覆盖裸露颅骨.结果治疗58例,异体皮移植、自体皮移植、皮瓣及扩张后皮瓣修复,1期伤口愈合46例,延期愈合10例,仅有2例部分撕脱皮肤制成的皮瓣移植后尖端坏死,经再次手术修复创面愈合.肢体截除4例,其中1例延期截肢.结论多部位撕脱伤主要是撕脱皮肤和部分撕脱皮肤的再利用,只要依据保留皮瓣的4条标准准确判断,选择修复方法妥当,撕脱皮肤舍弃的相对较少或全部利用,创面修复就比较容易,受伤区功能可最大限度恢复,外观也能达到整形效果,否则手术次数多,住院时间长,费用高,最后效果恢复也不甚理想.

Discussion and Plastic Repair of Multi-part Avulsion Injury

Objective To discuss the treatment of different localized avulsion injury and the judgment of reuse or discard of the avulsed flap. Methods Retrospectively summarize and analyze plastic restoration of 58 cases of avulsion wounds, and treatment regimen is determined according to the size and shape of avulsion, including ①avulsed skin trimmed as intermediate split thickness skin graft; ②autologous skin graft after allogenous skin coverage after debridement; ③local flap graft covering the exposed nerves, blood vessels, bones and testicles, other wounds is covered by auto graft; ④keep part of the avulsed skin to graft suture back; ⑤expanded flap graft covering the exposed skull. Results Of 58 cases, 46 healed in first stage, 10 delayed, and 2 of the avulsed skin graft suture back is complicated with flap tip necrosis and was repaired by the secondary operation. Four cases performed limb amputation, including one delayed amputation. Conclu- sion The reparation of avulsion injury is the reuse of all or part of the avulsed skin. As long as the accurate judgment whether reserve the avulsed flap is adopted according to the four standards, and the correct method is selected, the repara- tion of the wound will be easy, and the function of wound part will recover to the maximum and the appearance achieves plastic effect. Otherwise there will be more operation, longer hospital stay and high cost and the effect of recovery is not i- deal either.