CAJ | 학술논문

目的探讨毁损性弃用肢体复合组织瓣修复严重交通伤导致的大面积皮肤软组织缺损的疗效.方法自2006年1月至2009年12月共收治12例严重交通伤致肢体毁损并大面积皮肤软组织缺损患者,男8例,女4例；年龄9 ～ 55岁,平均31.8岁.复合组织瓣类型及修复部位:桡动脉毁损性弃用肢体复合组织瓣修复上肢毁损伤并头面部皮肤软组织缺损4例,上臂巨大毁损性弃用肢体复合组织瓣修复上肢毁损伤并颈、腋及侧胸腹部皮肤软组织缺损3例,足部及小腿毁损性弃用肢体复合组织瓣修复下肢毁损伤并对侧足部及小腿皮肤软组织缺损5例.上肢复合组织瓣面积为5 cm×10 cm～20 cm×30 cm,下肢复合组织瓣面积为10 cm×20 cm～30 cm×40 cm.受伤至手术时间为2～7h,平均4.0h.结果 12例移植毁损性弃用肢体复合组织瓣全部成活,其中3例皮瓣术后创面感染,经创缘负压封闭引流后愈合.术后12例患者全身状况良好,经13 ～ 25 d(平均21d)创面愈合,6个月后8例患者受区可有两点辨别觉,4例恢复部分粗略触觉.12例患者术后获6～12个月(平均8个月)随访,移植皮瓣颜色、质地良好,外形不臃肿.结论毁损性弃用肢体复合组织瓣可彻底覆盖修复巨大创面,提高患者生存质量,是一种牺牲局部、保护整体的有效选择.
목적 탐토훼손성기용지체복합조직판수복엄중교통상도치적대면적피부연조직결손적료효.방법 자2006년1월지2009년12월공수치12례엄중교통상치지체훼손병대면적피부연조직결손환자,남8례,녀4례；년령9 ～ 55세,평균31.8세.복합조직판류형급수복부위:뇨동맥훼손성기용지체복합조직판수복상지훼손상병두면부피부연조직결손4례,상비거대훼손성기용지체복합조직판수복상지훼손상병경、액급측흉복부피부연조직결손3례,족부급소퇴훼손성기용지체복합조직판수복하지훼손상병대측족부급소퇴피부연조직결손5례.상지복합조직판면적위5 cm×10 cm～20 cm×30 cm,하지복합조직판면적위10 cm×20 cm～30 cm×40 cm.수상지수술시간위2～7h,평균4.0h.결과 12례이식훼손성기용지체복합조직판전부성활,기중3례피판술후창면감염,경창연부압봉폐인류후유합.술후12례환자전신상황량호,경13 ～ 25 d(평균21d)창면유합,6개월후8례환자수구가유량점변별각,4례회복부분조략촉각.12례환자술후획6～12개월(평균8개월)수방,이식피판안색、질지량호,외형불옹종.결론 훼손성기용지체복합조직판가철저복개수복거대창면,제고환자생존질량,시일충희생국부、보호정체적유효선택.
Objective To report clinical outcomes of de-boned composite tissue flaps used in repair of massive soft tissue injuries caused by traffic accidents.Methods From January 2006 to December 2009,we used de-boned composite flaps to treat 12 patients with massive soft tissue injuries caused by traffic accidents.They were 8 males and 4 females,aged between 9 and 55 years old(average,31.8 years).We used 4 de-boned composite flaps with radial artery to repair smashed wounds at the upper limb plus soft tissue defects at the face and head,3 large upper arm de-boned composite flaps to repair smashed wounds at the upper limb plus soft tissue defects at the neck,armpit and flank,5 foot and lower leg de-boned composite flaps to repair smashed wounds at the lower limb plus soft tissue defects at the opposite toot and leg.The average area of upper limb composite flaps ranged from 5 cm × 10 cm to 20 cm × 30 cm; the average area of the lower limb flaps ranged from 10 cm × 20 cm to 30 cm × 40 cm.All the cases received operation in 2 to 7 hours(average,4.0 hours)after the accident.Results All the patients were in good systematical condition after operation and all the flaps survived.Three cases got wound intection which responded to sealed vacuum drainage.The wounds healed in an average time of 21 days(from 13 to 25 days).Eight cases recovered two-point discrimination in the recipient area 6 months post-operation,and 4 recovered partial sense of touch.An average follow-up of 8 months(from 6 to 12months)fnund the flaps in satisfactory outline and good quality.Conclusion Because de-boned conposite flaps can thoroughly cover and repair nassive soft tissue defects,they make a good balance between local invasion and whole cure to improve the patient's quality of life.