摘要
目的探讨采用带蒂皮瓣-皮片联合体原位回植联合封闭负压引流技术(NPWT治疗手部皮肤不全撕脱伤的临床疗效。方法采用带蒂皮瓣-皮片联合体原位回植联合NPWT治疗手部皮肤不全撕脱伤患者45例,根据撕脱皮肤回植成活情况判断手术疗效,并对手部功能恢复情况(手功能评分越高恢复情况越好)及手术满意度进行评估。结果 45例手部不全撕脱皮肤制备成带蒂皮瓣-皮片联合体回植后全部一期成活,其中3例撕脱皮肤远端皮缘部分坏死,经加强换药后均获得甲级愈合。手术疗效优35例、良7例、可3例,优良率93.3%。所有患者术前与术后1个月手功能评分比较差异有统计学意义(P <0.017);术后1个月与术后3个月手功能评分比较差异有统计学意义(P <0.017)。术后3个月随访,患者满意度评分为(84.33±10.34)分,总体满意率为95.6%,未出现明显并发症。结论采用带蒂皮瓣-皮片联合体原位回植联合封闭NPWT治疗手部皮肤不全撕脱伤的疗效显著,值得临床推广应用。
Objective To investigate the clinical efficacy of pedicle flap and skin combination in situ replantation combined with closed negative pressure wound therapy(NPWT) in the treatment of incomplete avulsion of hand skin.Methods Forty-five patients with incomplete avulsion of hand skin were treated pedicle flap and skin combination in situ replantation combined with closed NPWT.The operation efficacy was judged according to the survival of avulsion skin replantation,and the recovery of hand function(the higher the score of hand function,the better the recovery) and the degree of surgical satisfaction were evaluated.Results All45 cases with incomplete avulsed hand skin survived the first stage after the combination of pedicle flap and skin was prepared and replanted.Among them 3 cases had partial necrosis at the distal margin of the avulsed skin,and they all achieved grade A healing after enhanced dressing change.The surgical effect was excellent in 35 cases,good in 7 cases,and fair in 3 cases,with an excellent and good rate of 93.3%.There was a statistically significant difference of hand function scores of all patients between pre-operation and one month after operation(P <0.017).The difference of hand function scores between 1 month after surgery and 3 months after surgery was statistically significant(P <0.017).After 3 months of postoperative follow-up,the patient satisfaction score was(84.33±10.34),and the overall satisfaction rate was 95.6% without obvious complications.Conclusion The therapeutic effect of pedicled lap and skin combination in situ replantation combined with closed NPWT on incomplete avulsion of hand skin is remarkable and worthy of clinical optimization and application.
作者
曾锦浩
陈泽华
熊懿
李征
吴文溢
张振伟
Zeng Jinhao;Chen Zehua;Xiong Yi;Li Zheng;Wu Wenyi;Zhang Zhenwei(Department of Hand Surgery,Shenzhen Hospital of Integrated Traditional Chinese And Western Medicine,Shenzhen 518104,China)
出处
《新医学》
2020年第7期534-538,共5页
Journal of New Medicine
基金
深圳市宝安区中青年骨干高级专科医师培养项目(深宝卫计[2017]396)
深圳市中西医结合医院“雏鹰人才”培养项目([2020]3)。
关键词
带蒂皮瓣
原位回植
封闭负压引流技术
皮肤不全撕脱伤
Pedicle flap
In situ replantation
Closed negative pressure wound therapy
Incomplete skin avulsion
