小儿下肢皮肤撕脱伤综合治疗体会.docVIP

小儿下肢皮肤撕脱伤综合治疗体会 　　[摘要]目的：探讨小儿下肢皮肤急性撕脱后利用封闭式负压引流技术联合植皮治疗等综合治疗方法，以进一步提高手术疗效。方法：首先处理休克及严重合并伤，稳定病情后急诊手术彻底清创，根据皮肤具体受损特点修复创面，对撕脱皮片进行修整，选择性反植，创面采用VSD敷料封闭覆盖，加压包扎。术后加强抗感染等对症治疗。结果：11例患儿5～7d后拆除VSD敷料，观察皮片愈合情况，10例患儿皮瓣成活率达95%以上，1例患儿游离皮片远端有少许皮肤坏死，再次手术植皮，术后伤口二期愈合。结论：针对小儿本身的情况以及撕脱伤的特点选择相应植皮治疗方式，取得了良好的术后效果。 　　[关键词]下肢；皮肤；撕裂伤；封闭式负压引流技术；植皮术 　　[中图分类号]R622 [文献标志码]A [文章编号]1008-6455（2015）23-0015-02 　　Abstract： Objective This paper is to explore the results when VSD（vacuum sealing drainage）， combined with skin grafting，is used to treat avulsion in lower extremities of infants，and to further improve the effect of future similar operations. Methods First，coma and serious assisted injuries were treated first to put the patient in a stable condition and then the emergency operation was carried out.In the process，the injury was cleaned thoroughly and the wound was repaired and trimmed in accordance with the concrete condition of the injury.Some part of the injured skin was carefully selected to be grafted back on the wound，and the wound was completely covered with the VSD dressing and pressure dressing.After the operation，measures were taken to curb infection. Results 5-7days after the operation，the VSD dressing was removed and careful observation shows that，among 11 infants，10 infants had a survival rate of the skin flap as high as over 95%，and minor necrosis on the edge of the free skin happens to one infant and was repaired by the second skin grafting. Conclusion Good postoperative results are achieved when effective skin grafting methods are used in correspondence to the concrete situation of the infants and of avulsion in lower extremities of the infants. 　　Key words：lower extremity；skin；avulsion；VSD；skin grafting 　　随着现代社会经济高速发展，车辆增多的同时交通事故也急剧增加，儿童好动，且自我保护意识薄弱，因此更易发生交通事故[1]。特别是以骨折伴皮肤撕脱，合并肌腱、神经组织损伤，以及皮肤软组织缺损，皮肤血液循环破坏严重，治疗困难。因此对皮肤撕脱伤及创面的处理尤为关键。现收集笔者所在科室2013年1月-2015年5月收治的11例皮肤撕脱伤，均痊愈出院，效果满意。 　　1 临床资料 　　1.1 一般资料 　　本组11例患者中，男7例，女4例；年龄3～12岁，平均6.4岁。受伤原因：车祸致伤9例，机械致伤2例。均为下肢撕脱伤，受伤至手术时间1～15h。