CAJ | 학술논문

目的：分期联合应用负压封闭引流技术（VSD）治疗特大面积头皮撕脱伤。方法早期应用中厚植皮的方法修复颅骨膜或软组织存在的创面；颅骨外露部行颅骨皮质密集钻孔去外板至板障层，应用 VSD 敷料将整个植皮区及颅骨钻孔区创面完全覆盖并持续负压封闭引流。7～10 d 后去除 VSD 敷料，观察植皮片存活情况并换药至颅骨钻孔区肉芽均匀覆盖，后期中厚大张网状植皮联合 VSD 修复残余创面。结果5例早期移植中厚皮片基本全部存活，后期中厚植皮成活90％以上。平均住院天数约为52 d。结论特大面积头皮撕脱伤患者在急诊或经治疗生命体征平稳后，行创面中厚皮片移植、颅骨外露区去外板至板障层，联合应用负压封闭引流装置进行治疗，能够提高植皮片成活率以及植皮片存活质量，值得临床推广应用。
목적：분기연합응용부압봉폐인류기술（VSD）치료특대면적두피시탈상。방법조기응용중후식피적방법수복로골막혹연조직존재적창면；로골외로부행로골피질밀집찬공거외판지판장층，응용 VSD 부료장정개식피구급로골찬공구창면완전복개병지속부압봉폐인류。7～10 d 후거제 VSD 부료，관찰식피편존활정황병환약지로골찬공구육아균균복개，후기중후대장망상식피연합 VSD 수복잔여창면。결과5례조기이식중후피편기본전부존활，후기중후식피성활90％이상。평균주원천수약위52 d。결론특대면적두피시탈상환자재급진혹경치료생명체정평은후，행창면중후피편이식、로골외로구거외판지판장층，연합응용부압봉폐인류장치진행치료，능구제고식피편성활솔이급식피편존활질량，치득림상추엄응용。
Objective To perform staging joint application of vacuum sealing drainage(VSD)technology in the treatment of large ar-ea of scalp avulsion injury.Methods The method of medium thickness skin graft was early applied to repair skull film or soft tissue wound;skull exposure of line intensive drilling skull cortex to plate was used to the diploe layer,and VSD dressing area and skull drilling area com-pletely covered the entire graft and continuously closed negative pressure drainage was applied.After 7 ~10 d the VSD dressings were re-moved,skin grafts in growth and the growth condition of granulation in bone exposed area were observed,switching to granulation uniform cov-erage,and skull drilling area in large and thick late mesh skin graft united with VSD were used to repair the remnant wounds.Results Near-ly all 5 cases of early transplantation of thick skin survived,and the survival of late medium thickness skin graft was about 90%.On average there were about 52 days of such confinement.Conclusion For patients with large area of scalp avulsion injury in the emergency department or after treatment of stable vital signs,thick skin grafts in the wound,skull exposed area to plate the diploe zone and combined use of negative pressure closed drainage device for treatment can increase the survival rate of skin graft,shorten such confinement,and reduce hospitalization expenses,thus it is worth clinical popularization and application.