难愈性创面外科治疗.docVIP

难愈性创面外科治疗 　　[摘要]目的：总结修复难愈性创面的治疗经验。方法：2003年1月～2007年12月，采用不同的修复方法治疗67例难愈性创面，对其临床治疗与随访资料进行分析总结。结果：除2例胫骨凿孔、培养肉芽组织后植皮完全坏死外，板障层移植皮片与短管状骨面植皮片、皮瓣100%成活，伤口Ⅰ期愈合；对于存在数月至数年的糖尿病足、下肢静脉曲张后溃疡的患者，在全身情况维持稳定的同时，应用简易封闭负压治疗技术，创面局部改善后，行皮瓣或皮片移植术，皮瓣、皮片成活良好。经术后2～12月随访，创面愈合良好，功能恢复满意。结论：短管状骨骨髓面或板障层植皮、多种皮瓣以及封闭负压引流技术综合运用可较好治疗难愈性创面。 　　[关键词]难愈性创面；创面修复；封闭负压引流技术 　　[中图分类号]R622[文献标识码]A[文章编号]1008-6455（2008）10-1444-03 　　 　　Surgical treatment of unhealing wound 　　ZHANG Xian-ying，LIU Yi，ZHANG Xu-sheng，ZHANG Bin，ZHANG Cheng，LI Yu-huan，YANG Xue-li 　　（Department of Burn and Plastic Surgery, Lanzhou General Hospital, Lanzhou Command, PLA,lanzhou,730050,China） 　　 　　Abstract:ObjectiveTo sum up the experience in repairing wound impaired.Methods From Jan.2003 to Dec.2007, different surgical methods were employed in 67 patients. Their clinical materials and follow-up results were analyzed.ResultsApart from chisel tibia completely necroses (2 cases) on skin grafts of cultivantinggranulation tissue, the survival rates of skin grafts and skin flaps, which skin grafts on the marrow surface or diploic layer or short bone or flat bone, were 100%, and the wounds healed on the first stage. Diabetic ulcer, phlebeurysma ulcer or other unhealing wound were used by vacuum-assisted closure technology under the safe condition from months to years. Under sustaining stability, the skin grafts and skin flaps on cultivantinggranulation tissueby vacuum-assisted closure technology were taken well. The follow-up results from two to twelve months post-operation showed satisfactory wound repairing and functional recovery.Conclusions Skin grafting on the marrow surface or diploic layer or short bone might be used to repair unhealing wound. Several skin flaps and vacuum-assisted closure technology are good methods to repair unhealing wound. 　　Key words: unhealing wound; wound repair; vacuum-assisted closure technology 　　 　　烧创伤、放射性损伤、糖尿病、血管病变等原因造成的皮肤软组织慢性溃疡，在临床治疗中，由于创面周围皮肤软组织条件差，创面难愈，修复困难。我科自2003年1月～2007年12月采用多种治疗方法进行修复，取得了满意