【摘要】 目的总结严重大面积皮肤撕脱复合伤感染坏死创面的修复方法。方法对1996年1月至2011年6月江门市人民医院收治严重大面积皮肤撕脱复合伤合并创面感染坏死21例,采取彻底清除坏死组织,充分引流,对肉芽创面及坏死感染程度相对较轻创面予自体皮片移植,坏死感染较严重及创面较深者采用负压引流技术,合并有肌腱和骨外露创面则利用皮瓣、肌皮瓣或游离皮瓣移植修复创面。结果本组21例46个创面经分次手术后全部治愈。其中应用负压引流技术9例次,自体皮片移植55例次,局部皮瓣转移26例次,阔筋膜张肌肌皮瓣转移13例次,阴股沟皮瓣转移6例次。除5例次移植皮瓣远端部分坏死外,其余均成活良好。创面完全愈合时间为31～102d,平均(48.10±12.14)d。结论严重大面积皮肤撕脱复合伤急症处理要及时合理,彻底清创和充分引流是防止创面进一步恶化的关键,选择正确的修复方法可促进感染坏死创面早日愈合,有效改善功能与外观。更多还原

【Abstract】 Objective To summarize the treatment methods of severe large area of skin avulsion injury complicated with infected and necrotic wound.Methods Twenty-one cases of severe large area of skin avulsion injury complicated with infected and necrotic wound were admitted to People’s Hospital of Jiangmen from January 1996 to June 2011.Necrotic tissues were debrided and discharge was drained.Wound with granulation and less infection and necrosis were auto-grafted.Negative pressure drainage was applied to deep wound and wound with severe infection and necrosis.Wound with tendons and bones exposure were grafted with skin flaps,myocutaneous flaps or free skin flaps.Results Forty-six wounds within 21 cases healed well after surgery by stages.Nine negative pressure drainage was applied.There were 55 skin auto-grafting,26 local flaps transplantation,13 tensor fasciae latae myocutaneous transplant and 6 groin skin flaps transplantaion.All grafts survived except 5 partial distal flaps necrosed.Wound healing time was 31 to 102 days with average 48.10±12.14 days.Conclusions Severe large area of skin avulsion injury should be treated promptly.Debridement and drainage are crucial to prevent worsening of wound.Infected and necrotic wound could be healed shortly with correct methods of treatment.The function and appearance could be improved effectively.更多还原