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自制简易封闭式负压引流装置修复四肢深度创面

目的 总结自制简易封闭式负压引流装置在深度创面修复中的作用及效果。 方法 2010年6月－12月，收治18例深度创面患者。男15例，女3例；年龄19～65岁，平均45.8岁。火焰烧伤3例，沸水烫伤5例，电烧伤3例，挫裂伤3例，糖尿病足3例，局部皮瓣修复术后1例。创面位于手背及手腕部10例，小腿下段5例，足背及足踝部3例。创面细菌培养示阳性8例。伴肌腱外露5例，软组织坏死6例，腕、踝关节无明显活动受限。创面范围5 cm × 3 cm～28 cm × 15 cm。病程3～46 d，中位病程16 d。彻底清创后用1层油纱、3～4层消毒无菌纱布覆盖创面，医用手术粘贴膜封闭创面，取一次性吸痰管作为引流管，与中心负压吸引系统连接，行持续负压引流。 结果 感染创面更换装置3～4次后细菌培养结果呈阴性，未见新增感染创面。患者均获随访，随访时间2～5个月。创面经持续负压引流治疗14～21 d后，4例创面自行愈合；14例创面面积明显缩小，见新鲜肉芽组织生长，二期植皮修复后皮片完全成活。 结论 自制简易封闭式负压引流装置具有促进坏死组织脱落、肉芽组织生长、创面愈合的作用，可为二期手术植皮创造有利条件，且价格低廉。

脱细胞异体真皮支架加自体刃厚皮移植治疗深度创面的临床观察

TISSUE FLAPS IN THE REPAIR OF WOUNDS AND CICATRICIAL DEFORMITIES

Various tissue flaps were used in the repair of 255 cases of the wounds from severe deep burns and cicatricial deformities. The types of flaps used included: 6 kinds of myocutaneous flaps in 54 cases, 10 kinds of axial cutaneous flaps in 50cases, 7 kinds of fasciocutaneous flaps in 44 cases, pedicled subcutaneous tissues flaps in 12 cases, pedicled thin skin flaps in 54 cases, subdermal vascular networks cutaneous flaps in 38 cases, and free skin flaps with arter ialization of vein flap, retrograd island cutaneous flap with great or small saphaneous vein, in each. The survival rate from the transplantation was 99.2 per cent, and the rate of primary healing was 94.5 per cent. According to the time interval between the injury and operation and the conditions of the wounds, the patients were divided into acute, infected and selective cases, and the rate of primary healing was 93.0 per cent, 91.6 per cent and 97.9 per cent, respectively. The selection of the types of flap to be used and the attentions to be taken dueing operation were discussed.