整形外科技术在糖尿病足截肢术中应用.doc

整形外科技术在糖尿病足截肢术中应用[摘要]目的：探讨应用整形外科技术行糖尿病足（diabetic foot,DF）截肢术的优越性。方法：改进传统截肢术，在合理确定截肢平面的前提下，应用整形外科基本原则实施截肢术：①严格无菌操作，无创面遗留，适度张力缝合，合理设计皮瓣；②减少组织损伤：不使用止血带，少缝扎肌肉断端；③于残端创腔留置负压引流管以消灭死腔，防止血肿。结果：6例常规截肢组1例发生皮瓣下血肿，2例发生局部感染，经局部换药引流后愈合；1例残端出现皮瓣坏死，伤口裂开，保守治疗无效后再次手术抬高截肢平面。5例应用整形外科方法截肢者除1例伤口渗液，经再次放置负压引流管，伤口换药1周后愈合外其余4例伤口皆Ⅰ期愈合，术后顺利佩戴假肢。结论：应用整形外科技术进行截肢较常规方法在保证DF残端一期愈合，缩短患者的住院时间，减少再次手术，提高安装假肢的成功率，提高患者的生活质量等方面具有优越性。 [关键词]糖尿病足；截肢术；整形外科 [中图分类号]R622[文献标识码]A[文章编号]1008-6455（2011）06-0911-03 Use of plastic surgery technology during the amputation of diabetic foot WU Jin-hua,HAN Yue,RU Zhan-feng (Department of Burn and Plastic Surgery,Xi’an Central Hospital, Xi’an 710003,Shaanxi,China) Abstract:ObjectiveTo observe thesuperiority of using plastic surgery technology on the amputation ofDF(diabetic foot).MethodsImprove the routine amputation technique, using plastic surgery technology on the amputation ofDF based on the amputation plane was determined rationally. ①Aseptic operation strictly,no wound leaving,suturing by modest tension , design the flap rationally；②Reduce tissue damage: nonuse tourniquet, less or not suturing the muscle of the stump;③Put the drainage tube into the cavity of the stump for suction drainage to eliminate the dead spaces and prevent hematoma. et al.ResultsAmong 11 patients undergoing amputation,6 received routine amputation technique,the other 5 were treated with modified technique. In the routine treatment group,1 complicated by sub skin-flap hematoma, 2 by infection which cured after the positive dressing. 1 by skin flap necrosis andwound dehiscence, received the reoperation when conservative treatment failed.In the modified technique group, 4 wound healing well,1 with wound discharge , we put the drainage tube under the flap,wound dressing for 1 week,then the wound healed, fitted with prosthetic limbs smoothly.ConclusionUsing plastic surgery technology on the amputation ofDF is superior to routine technique,it will ensure the healing of the stump by fi