CAJ | 학술논문

背景：四肢创伤常合并有肌腱、关节囊、骨质和内植物的外露，需要行皮瓣修复。研究表明，皮瓣是修复四肢创伤后软组织缺损的重要方法，但皮瓣围手术期软组织床的处理至今少有报道。 　　目的：文章探讨皮瓣修复创伤性软组织缺损的的围手术期处理策略。 　　方法：纳入二期皮瓣修复软组织缺损94例，术中止血带下清创，根据情况决定骨、肌腱、关节囊和内植物的取舍，大量生理盐水冲洗后，切取皮瓣覆盖创面，并恰当引流。 　　结果与结论：修复的皮瓣全部成活，5例骨外露病例皮瓣渗出，28例肌腱及关节囊外露组均正常愈合。未发生与保留内植物相关的并发症，但有3例出现骨折延迟愈合，1例出现骨不连。结果提示，皮瓣治疗围手术期的处理要引起关注，仔细清创，合理选择皮瓣，充分引流，规范应用抗生素是治疗成功的关键。对于创面中骨、肌腱、关节囊和钢板等所谓异物的处理，既要权衡利弊，更要适当放宽保留的指征。
배경：사지창상상합병유기건、관절낭、골질화내식물적외로，수요행피판수복。연구표명，피판시수복사지창상후연조직결손적중요방법，단피판위수술기연조직상적처리지금소유보도。 　　목적：문장탐토피판수복창상성연조직결손적적위수술기처리책략。 　　방법：납입이기피판수복연조직결손94례，술중지혈대하청창，근거정황결정골、기건、관절낭화내식물적취사，대량생리염수충세후，절취피판복개창면，병흡당인류。 　　결과여결론：수복적피판전부성활，5례골외로병례피판삼출，28례기건급관절낭외로조균정상유합。미발생여보류내식물상관적병발증，단유3례출현골절연지유합，1례출현골불련。결과제시，피판치료위수술기적처리요인기관주，자세청창，합리선택피판，충분인류，규범응용항생소시치료성공적관건。대우창면중골、기건、관절낭화강판등소위이물적처리，기요권형리폐，경요괄당방관보류적지정。
BACKGROUND:Traumatic soft tissue defects of the limbs are usual y accompanied with the exposure of tendon, joint capsule, bone or internal fixator, which can be reconstructed by skin flap. Previous research has shown that it is an important method to repair traumatic tissue defects with flaps. However, rarely research reports perioperative management about flap bed so far. OBJECTIVE:To explore the perioperative strategy for repairing traumatic soft tissue defects with revascularized flaps. METHODS:Total y 94 cases undergoing secondary skin flap repair were enrol ed. Intraoperative debridement using tourniquet was performed, and the wound was washed with mass of physiological saline. Whether the tissues, including bone, tendon, joint capsule and internal fixator, were reserved or not depended on their viability, and then the flaps were harvested to repair defects, and drainage was placed properly at last. RESULTS AND CONCLUSION:The flaps survived in al cases. Exudation occurred in 5 cases with the exposure of bone, and 28 cases with the exposure of tendon or joint capsule healed normal y. No complications were associated with the reservation of the internal fixators, but delayed-union occurred in three cases and nonunion in one case. These findings indicate that the perioperative treatment of the application of skin flap is worthy of attention. Careful debridement, advisable choice of the flap, efficient drainage and using antibiotic normatively are al keys. Treatment of the bone, tendon, joint capsule and internal fixator which are exposed should not only weigh the advantage and disadvantage, but also relax the indication of reserving them.