摘要
目的探讨间生态组织保护理念在急性放射性皮肤损伤修复中的应用价值。方法回顾性分析2014年2月至2018年1月,苏州大学附属第二医院整形外科收治的7例急性放射性损伤患者的临床资料,男3例,女4例,年龄45~76岁,会阴及臀部3例,胸壁2例,大腿2例。早期根据放射皮肤损伤情况采用局部分区换药、使用"三明治"换药材料,保护间生态组织;放射损伤2个月左右,坏死组织界限明确,清除坏死组织,尽量保存间生态组织;清创后进行负压封闭引流(VSD),并用生理盐水浸泡创面,使创面保湿、促进间生态组织向良性转化;10 d左右肉芽生长良好时,设计血供良好的肌皮瓣或皮瓣转移修复创面;皮瓣移植术后,继续使用VSD装置负压引流积液、促囊腔肉芽生长,促使皮瓣与基底及时建立血供,对创面的间生态组织进行最后的生物清洁作用,促进间生态组织向良性转化,减少进一步坏死。结果 7例Ⅳ度急性放射性损伤创面,术前换药时间为6~10周,清创后VSD应用时间为2~4周,除1例第1次手术后10 d皮瓣部分坏死、第2次手术皮瓣成活良好外,其余病例均一次完成皮瓣转移修复术,皮瓣成活良好,随访6个月至3年,无放射性溃疡产生。结论在术前、术中、术后及恢复阶段充分应用间生态组织保护理念,采取相应的治疗方法,可以促进急性放射性损伤后间生态组织向好的方向转化、控制皮肤软组织辐射损伤后坏死的范围及深度,为后期的皮瓣转移修复提供良好的基础,减少并发症。
Objective To evaluate the parabiotic tissue protection concept in the repairment of acute radiation-induced skin injury. Methods Seven patients(3 males and 4 females) with acute radiation injury treated in the Department of Plastic Surgery of the Second Affiliated Hospital of Soochow University from February 2014 to January 2018. The ages of patients ranged from 45 to 76 years. The wound areas include perineum and buttock (n=3), chest(n=2), and thigh(n=2). In the early stage, subregional " sandwich" surgical dressing was used to protect the probiotic tissue. Two months later, the necrotic tissue was clearly demarcated, the debridement was underwent, and the parabiotic tissue was preserved as far as possible. Vacuum sealing drainage(VSD)was applied to cover and soak wound with normal saline to moisturize the wound and promote the benign transformation of ecological tissue. Ten days later, the granulation grown well, and the skin flaps and myocutaneous flaps with good blood supply were designed to repair the wounds. The VSD device was continued to be used, to drain effusion under flap and promote the growth of cystic cavity granulation, with the purpose to promote blood supply of the skin flap, perform the final biological cleaning effect on the parabiotic tissue of the wound surface, promote the benign transformation of parabiotic tissue, and reduce the further necrosis. Results Seven patients with Ⅳ degree acute radiation-induced injury wounds were treated 6-10 weeks for surgery preparation, and 2-4 weeks for VSD-application after debridement. Except for part of flap was necrotized on 10th day after the first operation in one patient, all the other patients achieved satisfied outcome in a surgery. There was no further radiation-induced ulcer occurred during the 0.5-3 years of follow-up. Conclusions The concept of parabiotic tissue protection during preoperative, intraoperative and postoperative recovery phase can promote parabiotic tissue transformed to a good result after acute radiation injury, and reduce the size and depth of soft tissue necrosis, which can provide a good foundation for the secondary repair with flap and reduce complications.
作者
余道江
赵天兰
刘玉龙
王优优
王帅
张舒羽
曹建平
Yu Daojiang;Zhao Tianlan;Liu Yulong;Wang Youyou;Wang Shuai;Zhang Shuyu;Cao Jianping(Department of Plastic Surgery, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China;Nuclear Emergency Response Center, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China;School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou 215123, China)
出处
《中华整形外科杂志》
CAS
CSCD
北大核心
2019年第5期465-471,共7页
Chinese Journal of Plastic Surgery
基金
国家自然科学基金(81703157)
江苏省自然科学基金(BK20170354)
江苏省放射医学与防护重点实验室项目(KJS1763).
关键词
急性放射性皮肤损伤
修复
外科皮瓣
间生态组织
Acute radiation-induced skin injury
Repair
Surgical flap
Parabiotic tissue
