| 皮肤牵张闭合器在儿童肢体创面缺损的治疗应用 |
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投稿时间：2019-10-20
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| 作者 | Author | 单位 | Address | E-Mail |
| 蒋欣 |
JIANG Xin |
绵竹市人民医院骨科, 四川 绵竹 618200 |
Department of Orthopaedics, Mianzhu People's Hospital, Mianzhu 618200, Sichuan, China |
jiangxin1975@126.com |
| 向珩 |
XIANG Heng |
绵竹市人民医院骨科, 四川 绵竹 618200 |
Department of Orthopaedics, Mianzhu People's Hospital, Mianzhu 618200, Sichuan, China |
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| 刘利君 |
LIU Li-jun |
四川大学华西医院小儿外科, 四川 成都 610041 |
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| 杨晓东 |
YANG Xiao-dong |
四川大学华西医院小儿外科, 四川 成都 610041 |
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| 杨攀易 |
and YANG Pan-yi |
四川大学华西医院小儿外科, 四川 成都 610041 |
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| 期刊信息：《中国骨伤》2020年，第33卷，第8期，第757-760页 |
| DOI：10.12200/j.issn.1003-0034.2020.08.014 |
| 基金项目: |
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中文摘要:目的：回顾性分析可调式皮肤牵张闭合器在儿童大面积肢体创面缺损的临床应用价值。
方法：自2017年1月至2019年1月，应用可调式皮肤牵张闭合器处理儿童严重下肢创面缺损患儿11例，男9例，女2例，年龄4~12（8.3±2.7）岁，均为单侧下肢大面积创面缺损，其中车祸伤致肢体皮肤缺损4例，骨筋膜室切开减压术后无法缝合关闭3例，下肢骨折内固定术后钢板外露3例，皮肤撕脱伤清创缝合术后大面积缺血坏死1例。创面宽度（5.6±1.2）cm，长度（7.0±1.6）cm，均已行VSD负压引流、扩创缝合等处理，其中4例已行游离皮片植皮，2例已行局部皮瓣转移手术处理，植皮或皮瓣手术失败，前期治疗效果均不佳。
结果：术后经持续牵引5~14（10.5±2.6）d后创面闭合，未再行植皮或者皮瓣修复处理。无创缘血供不佳、皮肤感染坏死、末梢感觉障碍等并发症发生。11例患儿均获随访，随访时间3~18（8.9±3.8）个月。创缘皮肤呈线性愈合，瘢痕轻微。
结论：通过可调式皮肤牵张闭合器治疗儿童大面积肢体创面缺损，符合Wolff定律及组织自然重建理念，为治疗儿童肢体皮肤及软组织缺损提供了一种可供选择的有效方法。 |
| 【关键词】儿童 皮肤缺损 皮肤牵张术 |
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| Therapeutic application of skin stretch closure device for treatment of limbs skin wound defects in children |
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ABSTRACT Objective: To analyze the clinical application value of adjustable skin retractor in large area of limb wound defect in children.
Methods: From January 2017 to January 2019,11 children including 9 males and 2 females,aged 4 to 12(8.3±2.7) years old with severe lower extremity wound defects were treated with adjustable skin stretch and closure device,all of them were unilateral lower extremity large area wound defects,including 4 cases of limb skin defect caused by traffic accident,3 cases of failure to close after osteofasciotomy and decompression,3 cases of plate exposure after internal fixation of lower extremity fracture and 1 case of ischemic necrosis after debridement and suturing of skin avulsion. The width of the wound was (5.6±1.2) cm and the length was (7.0±1.6) cm. VSD negative pressure drainage and expanded suture were used in all the patients. Four of them had been treated with free skin graft and two had been treated with local flap transfer. The graft or flap operation failed,and the effect of the early treatment was not good.
Results: After 5 to 14(10.5±2.6) days of continuous traction,the wound was closed and no skin grafting or flap repair was performed. No complications such as poor blood supply,skin infection and necrosis,peripheral sensory disturbance occurred. All 11 patients were followed up for 3 to 18 (8.9±3.8) months. The wound edge skin was linear healing with slight scar.
Conclusion: It is in accordance with Wolff's law and the concept of natural tissue reconstruction to treat large-scale limb wound defects in children with adjustable skin stretch and closure device,which provides an effective method for the treatment of limb skin and soft tissue defects in children. |
| KEY WORDS Child Skin defect Skin stretch |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 蒋欣,向珩,刘利君,杨晓东,杨攀易.皮肤牵张闭合器在儿童肢体创面缺损的治疗应用[J].中国骨伤,2020,33(8):757~760 |
| 英文格式: | JIANG Xin,XIANG Heng,LIU Li-jun,YANG Xiao-dong,and YANG Pan-yi.Therapeutic application of skin stretch closure device for treatment of limbs skin wound defects in children[J].zhongguo gu shang / China J Orthop Trauma ,2020,33(8):757~760 |
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