CAJ | 학술논문

目的通过对典型病例的研究，探索反取皮植皮法治疗大面积背部撕脱伤的临床效果并进行相关分析。方法选择本院2008年6月至2012年6月收治的大面积背部皮肤撕脱伤患者56例作为病例组，将患者撕脱皮肤采用鼓式反取皮法制成筛状中厚皮片回植，皮片表面采用多聚乙烯醇明胶海绵材料（VSD）覆盖封闭，20～60 kPa负压持续吸引，根据负压引流情况撤除负压封闭引流后，每隔2天换药直至创面痊愈。选择本院2001年1月至2008年1月创伤中心收治的采用常规清创、引流、植皮的背部大面积撕脱伤患者40例作为对照组，观察两组患者临床效果。结果病例组中56例患者全部治愈，其中46例植皮完全成活；6例患者，皮肤Ⅰ期成活，小片状皮肤坏死，坏死区培养肉芽，移植刃厚皮片创面愈合；4例患者皮肤Ⅱ期成活，坏死区再次植皮或皮瓣转移修复，肉芽生长良好，创面得以愈合。与对照组相比，病例组的完全成活率较对照组显著提高（P＜0.01），病例组的换药次数及平均住院时间较对照组显著减少（P＜0.01）。两组间创面外形恢复和功能重塑，差异无显著性（P＞0.05）。结论反取皮植皮法联合负压封闭引流技术能促进皮片与创面的良好黏附，有利于皮片存活，对患者损伤小，是治疗大面积背部皮肤撕脱伤的一种实用方法。
목적통과대전형병례적연구，탐색반취피식피법치료대면적배부시탈상적림상효과병진행상관분석。방법선택본원2008년6월지2012년6월수치적대면적배부피부시탈상환자56례작위병례조，장환자시탈피부채용고식반취피법제성사상중후피편회식，피편표면채용다취을희순명효해면재료（VSD）복개봉폐，20～60 kPa부압지속흡인，근거부압인류정황철제부압봉폐인류후，매격2천환약직지창면전유。선택본원2001년1월지2008년1월창상중심수치적채용상규청창、인류、식피적배부대면적시탈상환자40례작위대조조，관찰량조환자림상효과。결과병례조중56례환자전부치유，기중46례식피완전성활；6례환자，피부Ⅰ기성활，소편상피부배사，배사구배양육아，이식인후피편창면유합；4례환자피부Ⅱ기성활，배사구재차식피혹피판전이수복，육아생장량호，창면득이유합。여대조조상비，병례조적완전성활솔교대조조현저제고（P＜0.01），병례조적환약차수급평균주원시간교대조조현저감소（P＜0.01）。량조간창면외형회복화공능중소，차이무현저성（P＞0.05）。결론반취피식피법연합부압봉폐인류기술능촉진피편여창면적량호점부，유리우피편존활，대환자손상소，시치료대면적배부피부시탈상적일충실용방법。
Objective Based on the research of the typical cases, explore the method of skin graft for treatment of large area back avulsed injury and correlation analysis. Methods Choose our hospital from June 2008 to June 2008, 56 patients with large area skin avulsion injury back as case group, the patients avulsion skin USES the drum in the legal system for leather into cribriform thick skin and implant, skin surface with polyvinyl alcohol more gelatin sponge materials (VSD) cover closed, 20~60 kPa pressure continues to attract, according to after removal of the closed negative pressure drainage the negative pressure drainage conditions, the bandage every 2 days until the wounds healed. Selection in our hospital between January 2001 and January 2008 trauma centers treated by routine debridement and drainage, skin graft, large area on the back of the avulsed injury patients as control group, 40 cases to observe clinical effect of two groups of patients. Results Cases in the group of 56 patients were all cured, in which 46 cases of skin grafts survived completely;In 6 patients, the skinⅠperiod survival, small patchy skin necrosis, necrotic area develop granulation, transplant split-thickness skin wound healing;SkinⅡperiod in 4 patients survival, necrotic area skin graft or skin lfap transfer to repair again, good growth of granulation wounds to heal. Compared with control group, the cases of complete survival rate than the control group had signiifcant increase (P<0.01), CPT of switching frequency and the average length of hospital stay compared with control group signiifcantly reduced (P < 0.01). Remodeling wound recovery and shape function between the two groups, there was no signiifcant difference (P>0.05). Conclusion The closed negative pressure drainage technology for leather skin graft method that can promote the skin a good adhesion with the wound, is advantageous to the lfap survival, little damage to the patients. It is the back of the treatment of large area skin avulsion injury of a kind of practical method.