封闭式负压引流技术联合皮瓣修复下肢皮肤软组织缺损
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摘要
目的探讨封闭式负压引流技术(vacuum sealing drainage,VSD)联合皮瓣治疗下肢皮肤软组织缺损的适应证、方法及临床疗效。方法回顾分析2006年6月-2009年11月,应用VSD联合皮瓣修复5例下肢皮肤软组织缺损患者(VSD组)临床资料,并与同期单纯皮瓣修复的10例下肢皮肤软组织缺损患者(非VSD组)进行比较。VSD组:男3例,女2例;年龄32～69岁,平均46岁。车祸伤3例,截肢术后皮肤坏死1例,骨折术后钢板外露1例。其中小腿下段1例,足踝2例,足背1例,前足1例。软组织缺损范围6.5cm×6.0cm～23.0cm×17.0cm。受伤至入院时间2h～2个月。非VSD组:男5例,女5例;年龄23～58岁,平均50岁。车祸伤6例,地震挤压复合伤1例,骨髓炎感染创面1例,骨折术后钢板外露2例。其中小腿下段1例,足踝3例,前足及足背4例,足跟2例。软组织缺损范围4cm×4cm～20cm×12cm。受伤至入院时间1h～2个月。两组患者一般资料比较,差异无统计学意义(P>0.05),具有可比性。结果 VSD组修复术前住院时间为(11.8±9.5)d,修复术后住院时间为(35.4±28.3)d,总住院时间(47.2±35.8)d,切取皮瓣面积(232.8±142.0)cm2,VSD治疗后创面感染率为0;非VSD组分别为(25.8±12.4)d,(33.9±28.1)d、(59.7±32.4)d、(97.3±93.6)cm2,常规抗感染治疗8～14d后创面感染率为80%。两组修复术前住院时间及皮瓣面积比较,差异有统计学意义(P<0.05);修复术后住院时间、总住院时间比较,差异均无统计学意义(P>0.05)。皮瓣修复术后VSD组1例、非VSD组2例皮瓣出现皮缘部分坏死,清创植皮或直接缝合后创面愈合良好;其余皮瓣全部成活,创面Ⅰ期愈合。供区切口均Ⅰ期愈合,植皮顺利成活。两组患者均获随访,随访时间5～41个月,平均22.1个月。两组皮瓣与周围皮肤色泽、质地相似,皮瓣受力处无破溃,无臃肿。结论 VSD联合皮瓣修复对及时控制创伤后下肢皮肤软组织缺损感染、改善创面血运、缩短术前准备时间、及早闭合创面、促进愈合有显著作用,但对修复术后治疗时间和总治疗时间的影响仍有待进一步观察和研究。
Objective To explore the feasibility,indications,and effects of vacuum sealing drainage(VSD) combined with flaps for repairing skin and soft tissue defects of lower limbs.Methods From June 2006 to November 2009,15 patients with skin and soft tissue defects of lower limbs were treated with VSD combined with flaps(VSD group,n=5) and only flaps(non-VSD group,n=10).In VSD group,there were 3 males and 2 females with an average age of 46 years(range,32-69 years),including 3 cases of traffic accident injury,1 case of skin necrosis after amputation,and 1 case of plate exposure after operation.The locations were lower leg in 1 case,ankle in 2 cases,dorsum of foot in 1 case,and forefoot in 1 case.The defect size ranged from 6.5 cm × 6.0 cm to 23.0 cm × 17.0 cm.The disease course ranged from 2 hours to 2 months.In nonVSD group,there were 5 males and 5 females with an average age of 50 years(range,23-58 years),including 6 cases of traffic accident injury,1 case of crush injury in earthquake,1 case of osteomyelitis,and 2 cases of plate exposure after operation.The locations were lower leg in 1 case,ankle in 3 cases,forefeet and dorsum of feet in 4 cases,and heel in 2 cases.The defect size ranged from 4 cm × 4 cm to 20 cm × 12 cm.The disease course ranged from 1 hour to 2 months.There was no significant difference in general data between 2 groups(P > 0.05).Results In VSD group,the preoperative hospitalization days,postoperative hospitalization days,and total hospitalization days were(11.8 ± 9.5),(35.4 ± 28.3),and(47.2 ± 35.8) days,respectively;the size of flap was(232.8 ± 142.0) cm2;and the infection rate after VSD-use was 0.In non-VSD group,the preoperative hospitalization days,postoperative hospitalization days,and total hospitalization days were(25.8 ± 12.4),(33.9 ± 28.1),and(59.7 ± 32.4) days,respectively;the size of flap was(97.3 ± 93.6) cm2;and the infection rate after 8 to 14 days of regular therapy was 80%.There were significant differences in the preoperative hospitalization days and the size of flap between 2 groups(P < 0.05).All flaps were alive except 3 partial necrosis(1 case in VSD group,2 cases in non-VSD group).The 3 flaps healed by skin grafting and suturing.The donor sites healed by first intention.All patients were followed up 5-41 months(22.1 months on average).All flaps were good in color,texture,and wear ability.Conclusion It is effective to apply VSD combined with proper flap to repair skin and soft tissue defects of lower limbs,which can cut down infection rate,improve blood supply,shorten the preoperative hospitalization days,and facilitate healing,but whether it can shorten the postoperative hospitalization days and total hospitalization days need further research.
Objective To explore the feasibility,indications,and effects of vacuum sealing drainage(VSD) combined with flaps for repairing skin and soft tissue defects of lower limbs.Methods From June 2006 to November 2009,15 patients with skin and soft tissue defects of lower limbs were treated with VSD combined with flaps(VSD group,n=5) and only flaps(non-VSD group,n=10).In VSD group,there were 3 males and 2 females with an average age of 46 years(range,32-69 years),including 3 cases of traffic accident injury,1 case of skin necrosis after amputation,and 1 case of plate exposure after operation.The locations were lower leg in 1 case,ankle in 2 cases,dorsum of foot in 1 case,and forefoot in 1 case.The defect size ranged from 6.5 cm × 6.0 cm to 23.0 cm × 17.0 cm.The disease course ranged from 2 hours to 2 months.In nonVSD group,there were 5 males and 5 females with an average age of 50 years(range,23-58 years),including 6 cases of traffic accident injury,1 case of crush injury in earthquake,1 case of osteomyelitis,and 2 cases of plate exposure after operation.The locations were lower leg in 1 case,ankle in 3 cases,forefeet and dorsum of feet in 4 cases,and heel in 2 cases.The defect size ranged from 4 cm × 4 cm to 20 cm × 12 cm.The disease course ranged from 1 hour to 2 months.There was no significant difference in general data between 2 groups(P > 0.05).Results In VSD group,the preoperative hospitalization days,postoperative hospitalization days,and total hospitalization days were(11.8 ± 9.5),(35.4 ± 28.3),and(47.2 ± 35.8) days,respectively;the size of flap was(232.8 ± 142.0) cm2;and the infection rate after VSD-use was 0.In non-VSD group,the preoperative hospitalization days,postoperative hospitalization days,and total hospitalization days were(25.8 ± 12.4),(33.9 ± 28.1),and(59.7 ± 32.4) days,respectively;the size of flap was(97.3 ± 93.6) cm2;and the infection rate after 8 to 14 days of regular therapy was 80%.There were significant differences in the preoperative hospitalization days and the size of flap between 2 groups(P < 0.05).All flaps were alive except 3 partial necrosis(1 case in VSD group,2 cases in non-VSD group).The 3 flaps healed by skin grafting and suturing.The donor sites healed by first intention.All patients were followed up 5-41 months(22.1 months on average).All flaps were good in color,texture,and wear ability.Conclusion It is effective to apply VSD combined with proper flap to repair skin and soft tissue defects of lower limbs,which can cut down infection rate,improve blood supply,shorten the preoperative hospitalization days,and facilitate healing,but whether it can shorten the postoperative hospitalization days and total hospitalization days need further research.
引文
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2裘华德.负压封闭引流技术.北京:人民卫生出版社,2003:87.
3李占玉,蒋晨,孙志勇,等.负压封闭引流在地震严重挤压伤中的应用.上海交通大学学报:医学版,2009,29(7):892-894.
4马丹,刘敏,马兵,等.VSD在5.12地震伤员下肢挤压伤后骨筋膜间隙综合征中的应用.重庆医学,2009,38(2):150-151.
5岑石强,黄富国,杨天府,等.封闭式负压引流技术在“5.12”汶川大地震伤员创面中的早期应用疗效.中国修复重建外科杂志,2009,23(6):657-659.
6张建,吴克俭,王刚,等.持续负压封闭吸引在晚期大面积皮肤撕脱伤合并感染中的应用.中国修复重建外科杂志,2009,23(10):1170-1172.
7李靖,陈绍宗,许龙顺.封闭负压引流技术对兔耳创面毛细血管密度及创面愈合的影响.中国临床康复,2004,8(5):904-905.
8杨润功,张伟佳,侯树勋,等.负压封闭引流在GustiloⅢB和ⅢC型开放性骨折感染治疗中的应用.中国骨肿瘤骨病,2008,7(4):193-197.
9姚元章,黄显凯,麻晓林,等.创伤性软组织缺损的负压封闭治疗.中国修复重建外科杂志,2002,16(6):388-390.
10Masquelet AC,Romana MC,Wolf G.Skin island flaps supplied by the vascular axis of the sensitive superficial nerve:anatomic study and clinical experience in the leg.Plast Reconstr Surg,1992,89(6):1115-1121.
11陈瑞光,叶伟雄,吴劲风,等.逆行腓肠神经营养血管岛状皮瓣的临床应用.中国修复重建外科杂志,2000,14(4):220-222.
12Nakajima H,Imanishi N,Fukuzumi S,et al.Accompanying arteries of the lesser saphenous vein and sural nerve:anatomic study and its clini-cal applications.Plast Reconstr Surg,1999,103(1):104-120.
13Costa-Ferreira A,Reis J,Pinho C,et al.The distally based island super-f icial sural artery?ap:clinical experience with36?aps.Ann Plast Surg,2001,46(3):308-313.
14黎晓华,陈实,李峻,等.保留腓肠神经的血管筋膜蒂皮瓣的解剖及临床研究.中华显微外科杂志,2008,31(6):401-404.
15黎晓华,李峻,王平,等.保留腓肠神经的血管筋膜蒂皮瓣的临床应用.中国矫形外科杂志,2005,13(18):1437-1438.
16Kim JS,Son DG,Choi TH,et al.An anatomic study of the superfi cial peroneal nerve accessory artery and its perforators,and clinical appli-cation of superfi cial peroneal nerve accessory artery perforator?aps.Ann Plast Surg,2008,60(6):710-716.
17陈超斌,陈振兵,王忠仁.腓浅神经营养血管皮瓣修复小腿、踝、足大面积软组织缺损疗效观察.现代中西医结合杂志,2009,18(34):4194-4196.
18唐举玉,李康华,刘俊,等.背阔肌皮瓣游离移植修复下肢巨大软组织缺损.中国修复重建外科杂志,2006,20(11):1087-1089.
19王露萍,董佳生.背阔肌皮瓣的解剖学研究及临床应用进展.组织工程与重建外科,2008,4(2):119-120.
2裘华德.负压封闭引流技术.北京:人民卫生出版社,2003:87.
3李占玉,蒋晨,孙志勇,等.负压封闭引流在地震严重挤压伤中的应用.上海交通大学学报:医学版,2009,29(7):892-894.
4马丹,刘敏,马兵,等.VSD在5.12地震伤员下肢挤压伤后骨筋膜间隙综合征中的应用.重庆医学,2009,38(2):150-151.
5岑石强,黄富国,杨天府,等.封闭式负压引流技术在“5.12”汶川大地震伤员创面中的早期应用疗效.中国修复重建外科杂志,2009,23(6):657-659.
6张建,吴克俭,王刚,等.持续负压封闭吸引在晚期大面积皮肤撕脱伤合并感染中的应用.中国修复重建外科杂志,2009,23(10):1170-1172.
7李靖,陈绍宗,许龙顺.封闭负压引流技术对兔耳创面毛细血管密度及创面愈合的影响.中国临床康复,2004,8(5):904-905.
8杨润功,张伟佳,侯树勋,等.负压封闭引流在GustiloⅢB和ⅢC型开放性骨折感染治疗中的应用.中国骨肿瘤骨病,2008,7(4):193-197.
9姚元章,黄显凯,麻晓林,等.创伤性软组织缺损的负压封闭治疗.中国修复重建外科杂志,2002,16(6):388-390.
10Masquelet AC,Romana MC,Wolf G.Skin island flaps supplied by the vascular axis of the sensitive superficial nerve:anatomic study and clinical experience in the leg.Plast Reconstr Surg,1992,89(6):1115-1121.
11陈瑞光,叶伟雄,吴劲风,等.逆行腓肠神经营养血管岛状皮瓣的临床应用.中国修复重建外科杂志,2000,14(4):220-222.
12Nakajima H,Imanishi N,Fukuzumi S,et al.Accompanying arteries of the lesser saphenous vein and sural nerve:anatomic study and its clini-cal applications.Plast Reconstr Surg,1999,103(1):104-120.
13Costa-Ferreira A,Reis J,Pinho C,et al.The distally based island super-f icial sural artery?ap:clinical experience with36?aps.Ann Plast Surg,2001,46(3):308-313.
14黎晓华,陈实,李峻,等.保留腓肠神经的血管筋膜蒂皮瓣的解剖及临床研究.中华显微外科杂志,2008,31(6):401-404.
15黎晓华,李峻,王平,等.保留腓肠神经的血管筋膜蒂皮瓣的临床应用.中国矫形外科杂志,2005,13(18):1437-1438.
16Kim JS,Son DG,Choi TH,et al.An anatomic study of the superfi cial peroneal nerve accessory artery and its perforators,and clinical appli-cation of superfi cial peroneal nerve accessory artery perforator?aps.Ann Plast Surg,2008,60(6):710-716.
17陈超斌,陈振兵,王忠仁.腓浅神经营养血管皮瓣修复小腿、踝、足大面积软组织缺损疗效观察.现代中西医结合杂志,2009,18(34):4194-4196.
18唐举玉,李康华,刘俊,等.背阔肌皮瓣游离移植修复下肢巨大软组织缺损.中国修复重建外科杂志,2006,20(11):1087-1089.
19王露萍,董佳生.背阔肌皮瓣的解剖学研究及临床应用进展.组织工程与重建外科,2008,4(2):119-120.
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