手外伤带蒂腹股沟皮瓣术后感染坏死原因分析及预防.docVIP

手外伤带蒂腹股沟皮瓣术后感染坏死原因分析及预防 　　[摘要]目的：分析手外科开放性创伤带蒂腹股沟皮瓣术后皮瓣发生感染坏死的原因，并寻找预防对策。方法：统计我院手外科2012年1月-2014年12月手外伤行带蒂腹股沟皮瓣术139例，其中男106例，女33例，年龄12～60岁，平均（37.28±4.72）岁，分析导致皮瓣坏死的原因，总结预防皮瓣坏死的相关措施。结果：入组患者中有5例术后早期发生并发症，发生率为3.59%，其中2例皮瓣边缘部分发生坏死，发生率1.44%，3例伤口发生感染，发生率2.15%，皮瓣部分坏死者通过积极地三抗治疗（抗炎、抗凝、抗痉挛）及伤口换药等处理，皮瓣最终全部成活。伤口感染者通过积极地抗感染治疗及伤口清创换药治疗，最终痊愈。结论：冲洗清创、皮瓣设计、体位及制动、手术操作、术后引流、环境及营养、术后抗感染治疗等影响到手外伤腹股沟带蒂皮瓣修复术后皮瓣感染及坏死的发生，要降低皮瓣感染坏死的发生率，应在围手术期针对前述影响因素给予妥善处理。 　　[关键词]手外伤；带蒂腹股沟皮瓣；修复；皮瓣感染坏死；原因；预防 　　[中图分类号]R622 [文献标志码]A [文章编号]1008-6455（2015）12-0021-03 　　The causes of infection and necrosis in hand injury pedicled groin flap and its preventive measures 　　SUN Hong-xu 1，WANG Yu-rong2，LIU Shao-yan3，WANG Dang3，LI Hong4 　　（1.Department of General Surgery，2.Department of Nursing，3.Department of Medical Education， 　　4.Operation Room，Peoples Hospital of Dangyang， Hubei，Dangyang 444100，Hubei，China） 　　Abstract： Objective To analysis the causes of infection and necrosis in hand injury pedicled groin flap and explore its preventive measures. Methods A total of 139 hand injury patients who accepted pedicled groin flap treatment from January 2012 to December 2014 were included，in which of them there were 106 male and 33 female，with a average age of 37.28 ± 4.72 （range 12-60） years. The causes and preventive measures of flap necrosis were analyzed and summarized. Results There were five patients appeared with early postoperative complications which accounted for 3.59%， in which of them there were two cases of marginal necrosis and three cases of wound infection accounting for rate 1.44% and 2.15% respectively.The flaps with marginal necrosis were finally survived by the active treatment of three anti- therapy （anti-inflammatory， anti- coagulation，anti- spasm） and wound dressing.The flaps with infection were survived by the treatment of anti infection and wound dressing. Conclusion The occurrence of infection and necrosis in hand injury pedicled groin flap were affected by wound irrigation and debridement，