地震后四肢开放伤口的治疗策略
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摘要
【目的】探讨地震后四肢开放伤口的治疗策略。【方法】本组伤员包括16人23处地震后四肢开放伤口,采用清创封闭负压引流处理伤口,伤口清洁后采用直接缝合、游离植皮术、邻位皮瓣和带蒂皮瓣转移闭合伤口。截肢感染残端的处理采用尽早彻底敞开伤口,充分引流,伤口清洁后立刻缝合伤口,必要时缩短残端。同时根据伤口创面分泌物培养结果选用敏感抗生素,对伤员的心理创伤、贫血、脱水和并发症积极治疗。【结果】本组伤员包括16人23处四肢开放伤口除1例91岁伤员外全部愈合。【结论】地震后四肢开放伤口采用正确的治疗策略,可以加速伤口愈合,尽快恢复肢体功能。
【Objective】 To summarize the strategy of treatment of open limb injury in earthquake. 【Methods】 Retrospective study of 16 patients with 23 open wounds on the limbs in earthquake. The patients were treated with debridement and vacuum-sealing drainage (VSD). Then the wounds were closed with saturation, skin grafting and pedicled skin flap. The treatment of infection amputation stump consisted of wound debridement, drain, and saturation. The sensitive antibiotics were administrated according to the cultural result of the wound. The psychic trauma and complications were actively treated. 【Result】 Except 1 patient , 16 patients with 23 wounds healed in time. 【Conclusion】 With the perfect treatment strategy to earthquake induced, open limb injury, the wound healing and the limb rehabilitation would be accelerated and the function of limbs would be quickly recovered.
【Objective】 To summarize the strategy of treatment of open limb injury in earthquake. 【Methods】 Retrospective study of 16 patients with 23 open wounds on the limbs in earthquake. The patients were treated with debridement and vacuum-sealing drainage (VSD). Then the wounds were closed with saturation, skin grafting and pedicled skin flap. The treatment of infection amputation stump consisted of wound debridement, drain, and saturation. The sensitive antibiotics were administrated according to the cultural result of the wound. The psychic trauma and complications were actively treated. 【Result】 Except 1 patient , 16 patients with 23 wounds healed in time. 【Conclusion】 With the perfect treatment strategy to earthquake induced, open limb injury, the wound healing and the limb rehabilitation would be accelerated and the function of limbs would be quickly recovered.
引文
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Fleischmann W,Strecker W,Bombelli M.Vacuumsealing as treatment of soft damage in open fractures[J].Unfallchirurg,1993,96(9):488-492.
Argcnta LC,Morykwas MJ.Vacuum assisted Closure:A new method for wound control and treatment:Clinical experience[J].Ann Piast Surg,1997,38(6):563-578.
Mendez-Eastman S.New treatment for an old pmblem:Negative pressure wound therapy[J].Nursing,2002,32(5):6.
Morykwas MJ,Argenta LC,Shelton-Brown EI,et al.Vacuum assisted c｜osure:A new method for woundcontrol andtreatment:Animal studies and basic foundation[J].Ann Plast Surg,1997,38(6):553-562.
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Duman H,Kulahci Y,Sengezer M.Fasciotomy incrush injury resulting from prolonged pressure in anearthquake in Turkey[J].Emerg Med,2005,22(1):78.
Vanholder R,van der Tol A,De Smet M,et al.Earthquakes and crush syndrome casualties:lessonslearned from the Kashmir disaster[J].Kidney Int,2007,71(1):17-23.
马明湘,郭屏,肖友益,等.地震灾后短期疾病谱的变迁及医疗预防应对措施探讨[J].中山大学学报:医学科学版,2008,29(4):372-374.
Fleischmann W,Strecker W,Bombelli M.Vacuumsealing as treatment of soft damage in open fractures[J].Unfallchirurg,1993,96(9):488-492.
Argcnta LC,Morykwas MJ.Vacuum assisted Closure:A new method for wound control and treatment:Clinical experience[J].Ann Piast Surg,1997,38(6):563-578.
Mendez-Eastman S.New treatment for an old pmblem:Negative pressure wound therapy[J].Nursing,2002,32(5):6.
Morykwas MJ,Argenta LC,Shelton-Brown EI,et al.Vacuum assisted c｜osure:A new method for woundcontrol andtreatment:Animal studies and basic foundation[J].Ann Plast Surg,1997,38(6):553-562.
Michaelson M.Crush injury and crush syndrome[J].World J Surg,1992,16(5):899-903.
Duman H,Kulahci Y,Sengezer M.Fasciotomy incrush injury resulting from prolonged pressure in anearthquake in Turkey[J].Emerg Med,2005,22(1):78.
Vanholder R,van der Tol A,De Smet M,et al.Earthquakes and crush syndrome casualties:lessonslearned from the Kashmir disaster[J].Kidney Int,2007,71(1):17-23.
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