CAJ | 학술논문

目的探讨膝部严重烧(创)伤后皮肤软组织缺损的系统治疗方法. 方法选择2009年1月-2011年12月笔者单位收治的20例严重烧(创)伤后膝部皮肤软组织缺损的患者,膝部皮肤缺损面积为5 cm×4 cm～30 cm×20 cm.创面行早期积极清创、VSD治疗、滴注冲洗控制感染,采用游离皮片+皮瓣或单纯皮瓣移植修复.皮瓣移植包括8例局部皮瓣移植,12例游离皮瓣移植.局部皮瓣包括局部旋转或易位皮瓣6例,隐动脉皮瓣2例.12例游离皮瓣包括股前外侧皮瓣8例,背阔肌肌皮瓣4例.皮瓣面积6 cm×5 cm～32 cm×22 cm.创面愈合后早期进行膝关节康复训练.结果采用游离皮片+皮瓣移植术的15例患者皮瓣移植后完全成活,其中13例完全愈合,2例因感染出现少部分皮片成活欠佳,经补充植皮后创面愈合.另5例单纯皮瓣移植患者中1例游离皮瓣下发生感染,经持续滴注冲洗、湿敷换药、手术清创并封闭创面后愈合.术后随访1～3年,膝关节活动良好. 结论采用包括积极清创、VSD治疗、滴注冲洗技术及自体大张皮片和(或)皮瓣移植等方法,并结合早期有效的康复训练在内的系统治疗,是修复膝部严重皮肤软组织缺损的有效方法.
목적 탐토슬부엄중소(창)상후피부연조직결손적계통치료방법. 방법 선택2009년1월-2011년12월필자단위수치적20례엄중소(창)상후슬부피부연조직결손적환자,슬부피부결손면적위5 cm×4 cm～30 cm×20 cm.창면행조기적겁청창、VSD치료、적주충세공제감염,채용유리피편+피판혹단순피판이식수복.피판이식포괄8례국부피판이식,12례유리피판이식.국부피판포괄국부선전혹역위피판6례,은동맥피판2례.12례유리피판포괄고전외측피판8례,배활기기피판4례.피판면적6 cm×5 cm～32 cm×22 cm.창면유합후조기진행슬관절강복훈련.결과 채용유리피편+피판이식술적15례환자피판이식후완전성활,기중13례완전유합,2례인감염출현소부분피편성활흠가,경보충식피후창면유합.령5례단순피판이식환자중1례유리피판하발생감염,경지속적주충세、습부환약、수술청창병봉폐창면후유합.술후수방1～3년,슬관절활동량호. 결론 채용포괄적겁청창、VSD치료、적주충세기술급자체대장피편화(혹)피판이식등방법,병결합조기유효적강복훈련재내적계통치료,시수복슬부엄중피부연조직결손적유효방법.
Objective To explore the methods of systemical treatment of defects of skin and soft tissue on the knees after severe trauma or burn.Methods Twenty patients with defects of skin and soft tissue on the knees after severe trauma or burn hospitalized in our center from January 2009 to December 2011.The injury areas on the knees ranged from 5 cm × 4 cm to 30 cm × 20 cm.The wounds were treated with radical debridement,vacuum sealing drainage,and douche through dripping to control infection in early stage.Then they were covered with transplantation of skin grafts plus flap or only with flap.Totally 8 local flaps (including 6 local rotation or transposition flaps and 2 saphenous artery flaps) and 12 free flaps (including 8 anterolateral thigh flaps and 4 latissimus dorsi musculocutaneous flaps) were used.The flap size ranged from 6 cm × 5 cm to 32 cm × 22 cm.The rehabilitation training of the knee joints was carried out in the early stage after wound healing.Results All free skin grafts and flaps used in 15 patients survived.Thirteen of them were primarily healed,while some small parts of skin grafts of the other two patients were in poor condition because of infection,and they healed after another session of skin transplantation.Infection occurred under the free flap in one of the 5 patients transplanted with flaps only,which was healed after continuous douche through dripping and another surgical debridement following wet dressing.The knee joints were in good function during the follow-up period of 1-3 years.Conclusions The systemic therapy of radical debridement,vacuum sealing drainage technique,douche through dripping,transplantation of large autologous grafts and flaps,and the early rehabilitation training are effective and reliable in repairing defects of skin and soft tissue at the knee region after severe injuries.