【摘要】 目的探讨皮肤牵张带(externaltissueextender,ETE)在治疗足踝部皮肤软组织缺损中的价值。方法2001年7月～2003年2月,应用皮肤ETE治疗8例足踝部软组织缺损患者,男6例,女2例;年龄5～85岁,平均51.6岁;非缺血性糖尿病足3例,右踝部外伤性皮肤缺损跟骨外露2例,左外踝皮肤溃疡1例,类风湿性关节炎行左踝关节融合术后伤口不愈合1例,右足背皮肤缺损跖骨外露1例;软组织缺损面积最大为5.0cm×12cm,最小为3.5cm×3.5cm。于伤口的两侧标记皮肤ETE的进针点和出针点,每针相隔1.8cm,距伤口边缘0.5cm。治疗期间每天牵拉硅胶带1～2次以维持合适的张力,直至伤口合拢。结果8例患者均获得随访,随访时间2～20个月,平均5个月。其中7例痊愈,1例类风湿性关节炎行左踝关节融合术后伤口不愈合的患者(伤口5cm×3.5cm)经皮肤ETE治疗后仍未愈合,考虑与长期应用激素,创口周缘皮肤所含胶原萎缩,所能承受的张力小有关;另外患者在治疗过程中出现伤口感染,致牵张的皮肤裂开,患者自动出院,随访半年仍未愈合。结论应用皮肤ETE治疗足踝部皮肤软组织缺损,手术时间短,对患者造成的局部损伤小,术后恢复快,尤其适用于老年非缺血性糖尿病足部溃疡患者。更多还原

【Abstract】 Objective To evaluate the clinical effects of external tissue extender in the treatment of soft tissue defect in ankle and foot. Methods From July 2001 to February 2003, 8 cases were admitted to our hospital, the patients included 6 males and 2 females with an average age of 51.5 years. The causes of soft tissue defect were diabetic in 3, posttraumatic with calcaneous or metatarsal exposure in 3, malnutritive ulcer in 1, and delayed wound healing following ankle arthrodesis for rheumatoid arthritis in 1. The area of defect ranged from 5.0 cm×12 cm to 3.5 cm×3.5 cm. The external tissue extender (Hojmed AB) consisted of suture needle, silicone tape and friction blocker, which controlled the pulling force no more than 3.5 N by internal friction in case of skin rupture. After the debridement of wound, sutures passed through full thickness of skin and stitches with a distance of 1.8 cm each other and 0.5 cm from skin edge. Tied the silicone tape, dressed the wound with vaseline gauze, and immobilized the limb with a cast. The silicone tapes were tightened 1 to 2 times every day until the wound was closed. Results All patients were followed up from 2 to 20 months (mean, 7 months). The defects of 7 patients were cured 2 to 3 weeks after skin closure. The cast was removed only after the wound healed well. However, one patient who was rheumatoid with the defect of 5 cm×3.5 cm failed at 6 months of final follow-up because of long-term glucocorticoid therapy, local infection and skin rupture. Conclusion External tissue extender can be a safe and easy alternative to treat the soft tissue defect in ankle and foot, especially for the defect in those aged diabetic foot. This method is worthy of being widely used because of its short operative period and minimal damage to the patients.更多还原