反鼓取皮在外伤后下肢皮肤软组织广泛撕脱伤中的应用(1)
[摘要]目的：探讨反鼓取皮在外伤后下肢皮肤软组织广泛撕脱伤中的应用效果。方法：选取38例外伤后下肢皮肤软组织广泛撕脱伤患者为研究对象，根据创面回植方式不同，分为观察组和对照组，观察组22例采用反鼓取皮制成中厚筛状自体皮回植，对照组16例采用制成全厚皮原位回植，观察比较两组患者的一期愈合率、皮片成活率、愈合时间、愈合质量以及外形和功能恢复情况。结果：观察组一期愈合20例，愈合率为90.9%，对照组一期愈合12例，愈合率为75.0%，差异有统计学意义(P<0.05)；观察组植皮区皮片成活率、一期愈合时间及愈合质量均优于对照组，差异有统计学意义(P<0.05)。结论：反鼓取皮制成大张中厚筛状自体皮回植应用于外伤后下肢皮肤软组织广泛撕脱伤患者的疗效可能优于制成全厚皮原位缝合回植，可提高皮片成活率，有效封闭一期创面，降低二期手术植皮率，促进外形和功能良好恢复。
[关键词]反鼓取皮；大张中厚筛状自体皮回植；全厚皮原位回植；软组织撕脱伤；外伤
[中图分类号]R622 [文献标志码]A [文章编号]1008-6455(2018)11-0096-04
, http://www.100md.com
Abstract： Objective To explore the drum for leather in extensive avulsion injury of soft tissue of the skin-on the lower limb after trauma application effect. Methods 38 exception injury patients with lower limb skin after extensive avulsion injury of soft tissue as the research object， according to the wound and implant in a different way， divided into the observation group and the control group. 22 cases were treated with the skin flap of the middle thickness made by drum type dermatome taken on reverse side in the observation group. 16 cases were adopted made full thickness skin in situ implant in the control group. The primary healing rate， skin graft survival rate， healing time， healing quality， appearance and functional recovery of the two groups were observed and compared. Results The primary healing rate of the observation group was 90.9%(20/22)， higher than that of the control group (75.0%，12/16)， the difference was statistically significant(P<0.05). The skin graft survival rate， primary healing time and healing quality of the observation group were better than those of the control group(P<0.05). Conclusion Anti-tympanic skin grafting with large， medium and thick sieve-shaped autologous skin was applied to patients with extensive avulsion of skin and soft tissue of lower extremities after trauma， its curative effect is good. It can improve the survival rate of skin graft， effectively seal the first stage wound， reduce the second stage skin graft rate， and promote the good recovery of shape and function.
, 百拇医药
Key words： drum type dermatome taken on reverse side； large and medium-thick sieve-shaped autologous skin replantation； full-thickness skin in situ replantation； soft tissue avulsion； trauma
大面积皮肤软组织撕脱伤比一般撕脱伤要少，但較一般撕脱伤要危重，且常伴重要脏器损伤，患者伤亡率较高[1]。近年来，随着交通运输业、机械工业的发展，大面积皮肤软组织撕脱伤也有日益增多的趋势，其中，外伤后下肢皮肤软组织广泛撕脱伤在该类患者中已较为多见[2]。有研究认为[3-4]，皮片成活是该类患者治疗成功的关键。传统治疗方法采取制成全厚皮原位回植或通过冷冻处理延期回植，皮片成活率较低，难以取得满意效果。因而，对广泛撕脱伤患者的治疗也一直是烧创外科探索的重点课题。有研究显示[5]，反鼓取皮制成中厚筛状自体皮回植能明显提高皮片成活率，植皮区一期愈合率以及愈合质量，促进外形和功能良好恢复，但反鼓取皮在外伤后下肢皮肤软组织广泛撕脱伤中的应用效果，仍需大量临床研究予以进一步证实。本研究回顾性分析2007年3月-2017年3月笔者医院收治的外伤后下肢皮肤软组织广泛撕脱伤患者38例的临床资料，旨在探讨反鼓取皮在该类患者中的应用效果，为临床上采用反鼓取皮制成大张中厚筛状自体皮回植创面，提高皮片成活率，有效封闭一期创面，促进患者外形及功能恢复，提供临床上的依据。, http://www.100md.com(温裕庆 李荣兴 钟毅)
[关键词]反鼓取皮；大张中厚筛状自体皮回植；全厚皮原位回植；软组织撕脱伤；外伤
[中图分类号]R622 [文献标志码]A [文章编号]1008-6455(2018)11-0096-04
, http://www.100md.com
Abstract： Objective To explore the drum for leather in extensive avulsion injury of soft tissue of the skin-on the lower limb after trauma application effect. Methods 38 exception injury patients with lower limb skin after extensive avulsion injury of soft tissue as the research object， according to the wound and implant in a different way， divided into the observation group and the control group. 22 cases were treated with the skin flap of the middle thickness made by drum type dermatome taken on reverse side in the observation group. 16 cases were adopted made full thickness skin in situ implant in the control group. The primary healing rate， skin graft survival rate， healing time， healing quality， appearance and functional recovery of the two groups were observed and compared. Results The primary healing rate of the observation group was 90.9%(20/22)， higher than that of the control group (75.0%，12/16)， the difference was statistically significant(P<0.05). The skin graft survival rate， primary healing time and healing quality of the observation group were better than those of the control group(P<0.05). Conclusion Anti-tympanic skin grafting with large， medium and thick sieve-shaped autologous skin was applied to patients with extensive avulsion of skin and soft tissue of lower extremities after trauma， its curative effect is good. It can improve the survival rate of skin graft， effectively seal the first stage wound， reduce the second stage skin graft rate， and promote the good recovery of shape and function.
, 百拇医药
Key words： drum type dermatome taken on reverse side； large and medium-thick sieve-shaped autologous skin replantation； full-thickness skin in situ replantation； soft tissue avulsion； trauma
大面积皮肤软组织撕脱伤比一般撕脱伤要少，但較一般撕脱伤要危重，且常伴重要脏器损伤，患者伤亡率较高[1]。近年来，随着交通运输业、机械工业的发展，大面积皮肤软组织撕脱伤也有日益增多的趋势，其中，外伤后下肢皮肤软组织广泛撕脱伤在该类患者中已较为多见[2]。有研究认为[3-4]，皮片成活是该类患者治疗成功的关键。传统治疗方法采取制成全厚皮原位回植或通过冷冻处理延期回植，皮片成活率较低，难以取得满意效果。因而，对广泛撕脱伤患者的治疗也一直是烧创外科探索的重点课题。有研究显示[5]，反鼓取皮制成中厚筛状自体皮回植能明显提高皮片成活率，植皮区一期愈合率以及愈合质量，促进外形和功能良好恢复，但反鼓取皮在外伤后下肢皮肤软组织广泛撕脱伤中的应用效果，仍需大量临床研究予以进一步证实。本研究回顾性分析2007年3月-2017年3月笔者医院收治的外伤后下肢皮肤软组织广泛撕脱伤患者38例的临床资料，旨在探讨反鼓取皮在该类患者中的应用效果，为临床上采用反鼓取皮制成大张中厚筛状自体皮回植创面，提高皮片成活率，有效封闭一期创面，促进患者外形及功能恢复，提供临床上的依据。, http://www.100md.com(温裕庆 李荣兴 钟毅)