自制肢体慢性创面闭合装置在瘢痕性下肢创面修复中的应用
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摘要
目的探讨自制肢体慢性创面闭合装置在下肢瘢痕性及复杂皮肤软组织缺损修复中的应用。方法 2014年1月—2017年1月,收治29例下肢复杂骨折合并皮肤软组织缺损患者。其中男19例,女10例;年龄21～66岁,平均31.1岁。致伤原因:交通事故伤14例,高处坠落伤5例,重物挤压伤4例,机器辗压伤4例,骨折术后钢板外露2例。骨折及皮肤缺损部位:小腿胫腓骨骨折并皮肤缺损26例,跖骨骨折并足背皮肤缺损3例。皮肤缺损范围为5 cm×3 cm～18 cm×8 cm。受伤至入院时间5～31 d,平均14.3 d。患者均采取彻底清创、伤口敞开引流,自制肢体慢性创面闭合装置结合Ilizarov牵张技术行皮肤软组织缓慢牵拉。待创面清洁、肉芽组织新鲜,两侧皮肤靠拢后二期根据实际创面大小植皮或直接缝合封闭创面。结果患者术后均获随访,随访时间8～20个月,平均13个月。29例患者经肢体慢性创面闭合装置结合Ilizarov技术牵拉治疗1～2次,平均1.3次后感染得到控制,肉芽组织生长良好。治疗过程中患者疼痛不明显,依从性好。创面均达临床愈合,无皮肤牵拉并发症发生,创面仅形成线状或片状瘢痕。结论自制肢体慢性创面闭合装置修复下肢复杂瘢痕性创面效果较好,且手术难度小,可操作性强。
Objective To investigate the effectiveness of self-made limb chronic wound closure device in the treatment of scarred lower limbs and complex skin and soft tissue defects. Methods Between January 2014 and January2017, 29 patients with complex fractures of the lower extremities and skin and soft tissue defects were treated. There were19 males and 10 females with an average age of 31.1 years(range, 21-66 years). The causes of injury included 14 cases of traffic accidents, 5 cases of falling from height, 4 cases of heavy object crushing injury, 4 cases of mechanical crushing injury, and 2 cases of exposed steel plate after fracture. There were 26 cases of calf fracture and skin defect, 3 cases of metatarsal bone fracture and skin defect of the foot. The skin defect ranged from 5 cm×3 cm to 18 cm×8 cm. The time from injury to admission was 5-31 days, with an average of 14.3 days. All patients underwent a thorough debridement,open wound drainage, self-made chronic wound closure device combined with Ilizarov stretching technique for a slow skin and soft tissue traction. After the wound was cleaned up and the granulation tissue was freshened, the skins on both sides were closed, and then proceed to the second stage operation of skin grafting or direct suture closure based on the size of the wound. Results All patients were followed up 8-20 months, with an average of 13 months. Twenty-nine patients were treated with self-made chronic wound closure device combined with Ilizarov technique for 1-2 times with an average of 1.3 times, then the wound infection was controlled and the granulation tissue grew well. In the course of treatment,the pain was not obvious and the patients had good compliance. All patients' wounds healed clinically without skin traction complications and formed linear or flaky scars. Conclusion The self-made chronic wound closure device is e ffective in repairing complex scarred wounds of lower extremities, and it is easy to operate.
Objective To investigate the effectiveness of self-made limb chronic wound closure device in the treatment of scarred lower limbs and complex skin and soft tissue defects. Methods Between January 2014 and January2017, 29 patients with complex fractures of the lower extremities and skin and soft tissue defects were treated. There were19 males and 10 females with an average age of 31.1 years(range, 21-66 years). The causes of injury included 14 cases of traffic accidents, 5 cases of falling from height, 4 cases of heavy object crushing injury, 4 cases of mechanical crushing injury, and 2 cases of exposed steel plate after fracture. There were 26 cases of calf fracture and skin defect, 3 cases of metatarsal bone fracture and skin defect of the foot. The skin defect ranged from 5 cm×3 cm to 18 cm×8 cm. The time from injury to admission was 5-31 days, with an average of 14.3 days. All patients underwent a thorough debridement,open wound drainage, self-made chronic wound closure device combined with Ilizarov stretching technique for a slow skin and soft tissue traction. After the wound was cleaned up and the granulation tissue was freshened, the skins on both sides were closed, and then proceed to the second stage operation of skin grafting or direct suture closure based on the size of the wound. Results All patients were followed up 8-20 months, with an average of 13 months. Twenty-nine patients were treated with self-made chronic wound closure device combined with Ilizarov technique for 1-2 times with an average of 1.3 times, then the wound infection was controlled and the granulation tissue grew well. In the course of treatment,the pain was not obvious and the patients had good compliance. All patients' wounds healed clinically without skin traction complications and formed linear or flaky scars. Conclusion The self-made chronic wound closure device is e ffective in repairing complex scarred wounds of lower extremities, and it is easy to operate.
引文
1 Barrer S, Pavlides CA, Matsumoto T. Ideal laparotomy closure:comparison of retention sutures with new retention bridging devices. Am Surg, 1976, 42(8):582-584.
2 Baker SR. Fundamentals of expanded tissue. Head Neck, 1991,13(4):327-330.
3王春萍,翟明玉.自制皮肤牵张带在关闭骨筋膜室减张口中的应用.中国矫形外科杂志,2004,12(12):947-948.
4张金明,陈小萱,崔永言,等.应用皮肤牵张带治疗足踝部皮肤软组织缺损.中华骨科杂志,2004,24(1):29-31.
5李付彬,李衡,焦振清,等.应用皮肤牵张法闭合四肢创面.河北医药,2013, 35(7):1042-1043.
6 Liang MD, Briggs P, Heckler FR, et al. Presuturing-a new technique for closing large skin defects:clinical and experimental studies. Plast Reconstr Surg, 1988, 81(5):694-702.
7 Blomqvist G, Steenfos H. A new partly external device for extension of skin before excision of skin defects. Scand J Plast Reconstr Surg Hand Surg, 1993, 27(3):179-182.
8朱跃良,徐永清.缓慢的力量--Ilizarov技术在中国微言.医学与哲学,2014, 35(10B):8-10.
9 Kocialkowski A, Marsh DR, Shackley DC. Closure of the skin defect overlying infected non-union by skin traction. Br J Plast Surg, 1998, 51(4):307-310.
10鲁开化,夏文森,杨力,等.皮肤伸展术在创伤修复重建外科中的应用.中国修复重建外科杂志,1999,13(3):160-163.
11苑博,梁海东,王寿宇,等.新型拉杆式即时皮肤扩张器治疗肢体皮肤缺损.中国矫形外科杂志,2017, 25(4):371-373.
12廖军.橡皮筋持续牵张结合封闭负压引流治疗皮肤软组织缺损.实用骨科杂志,2016, 22(3):283-285.
13 Topaz M, Carmel NN, Topaz G, et al. Stress-relaxation and tension relief system for immediate primary closure of large and huge soft tissue defects:an old-new concept:new concept for direct closure of large defects. Medicine(Baltimore), 2014,93(28):e234.
14 Topaz M, Carmel NN, Topaz G, et al. A substitute for skin grafts,flaps, or internal tissue expanders in scalp defects following tumor ablative surgery. J Drugs Dermatol, 2014,13(1):48-55.
15 Ilizarov GA. The tension-stress effect on the genesis and growth of tissues. PartⅠ. The influence of stability of fixation and soft-tissue preservation. Clin Orthop Relat Res, 1989,(238):249-281.
16 Ilizarov GA. The tension-stress effect on the genesis and growth of tissues:PartⅡ. The influence of the rate and frequency of distraction. Clin Orthop Relat Res, 1989,(239):263-285.
17秦泗河,李刚.Ilizarov技术骨科应用进展.北京:人民军医出版社,2014:33.
18秦泗河.应力控制下的外固定与肢体功能重建登上自然哲学殿堂.中国修复重建外科杂志,2018, 32(10):1235-1237.
19朱跃良,徐永清,秦泗河.Ilizarov器械、技术和哲学蠡测.中国修复重建外科杂志,2018, 32(10):1238-1240.
20张子阳,臧建成,秦泗河.Ilizarov技术治疗烧伤后马蹄内翻足畸形.中国修复重建外科杂志,2018, 32(2):178-181.
21张子阳,窦雪娇,魏在荣.应用Ilizarov技术治疗烧伤后膝关节屈曲挛缩畸形.中国修复重建外科杂志,2018, 32(10):1271-1274.
2 Baker SR. Fundamentals of expanded tissue. Head Neck, 1991,13(4):327-330.
3王春萍,翟明玉.自制皮肤牵张带在关闭骨筋膜室减张口中的应用.中国矫形外科杂志,2004,12(12):947-948.
4张金明,陈小萱,崔永言,等.应用皮肤牵张带治疗足踝部皮肤软组织缺损.中华骨科杂志,2004,24(1):29-31.
5李付彬,李衡,焦振清,等.应用皮肤牵张法闭合四肢创面.河北医药,2013, 35(7):1042-1043.
6 Liang MD, Briggs P, Heckler FR, et al. Presuturing-a new technique for closing large skin defects:clinical and experimental studies. Plast Reconstr Surg, 1988, 81(5):694-702.
7 Blomqvist G, Steenfos H. A new partly external device for extension of skin before excision of skin defects. Scand J Plast Reconstr Surg Hand Surg, 1993, 27(3):179-182.
8朱跃良,徐永清.缓慢的力量--Ilizarov技术在中国微言.医学与哲学,2014, 35(10B):8-10.
9 Kocialkowski A, Marsh DR, Shackley DC. Closure of the skin defect overlying infected non-union by skin traction. Br J Plast Surg, 1998, 51(4):307-310.
10鲁开化,夏文森,杨力,等.皮肤伸展术在创伤修复重建外科中的应用.中国修复重建外科杂志,1999,13(3):160-163.
11苑博,梁海东,王寿宇,等.新型拉杆式即时皮肤扩张器治疗肢体皮肤缺损.中国矫形外科杂志,2017, 25(4):371-373.
12廖军.橡皮筋持续牵张结合封闭负压引流治疗皮肤软组织缺损.实用骨科杂志,2016, 22(3):283-285.
13 Topaz M, Carmel NN, Topaz G, et al. Stress-relaxation and tension relief system for immediate primary closure of large and huge soft tissue defects:an old-new concept:new concept for direct closure of large defects. Medicine(Baltimore), 2014,93(28):e234.
14 Topaz M, Carmel NN, Topaz G, et al. A substitute for skin grafts,flaps, or internal tissue expanders in scalp defects following tumor ablative surgery. J Drugs Dermatol, 2014,13(1):48-55.
15 Ilizarov GA. The tension-stress effect on the genesis and growth of tissues. PartⅠ. The influence of stability of fixation and soft-tissue preservation. Clin Orthop Relat Res, 1989,(238):249-281.
16 Ilizarov GA. The tension-stress effect on the genesis and growth of tissues:PartⅡ. The influence of the rate and frequency of distraction. Clin Orthop Relat Res, 1989,(239):263-285.
17秦泗河,李刚.Ilizarov技术骨科应用进展.北京:人民军医出版社,2014:33.
18秦泗河.应力控制下的外固定与肢体功能重建登上自然哲学殿堂.中国修复重建外科杂志,2018, 32(10):1235-1237.
19朱跃良,徐永清,秦泗河.Ilizarov器械、技术和哲学蠡测.中国修复重建外科杂志,2018, 32(10):1238-1240.
20张子阳,臧建成,秦泗河.Ilizarov技术治疗烧伤后马蹄内翻足畸形.中国修复重建外科杂志,2018, 32(2):178-181.
21张子阳,窦雪娇,魏在荣.应用Ilizarov技术治疗烧伤后膝关节屈曲挛缩畸形.中国修复重建外科杂志,2018, 32(10):1271-1274.
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