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上肢大面积皮肤撕脱伤反鼓取皮原位植皮9 例分析
In Situ Autologous Skin Grafting with Skin Flap Taken on Reverse Side Using Drum Type Dermatome in the Treatment of Large Area Skin Avulsion Wound of Upper Limbs (9 Case Reports)

陈殿伟,王庆生,汪强,蔡延深.上肢大面积皮肤撕脱伤反鼓取皮原位植皮9 例分析[J].中国烧伤创疡杂志,2012,24(6):460~462.

DOI：10.3969/j.issn.1001-0726.2012.6.009

英文关键词:Skin avulsion Autologous skin grafting with skin flap taken on reverse side using drum type dermatome Overhanging Layering dressing MEBO

基金项目:

作者	单位
陈殿伟	汕头市中心医院外六科
王庆生
汪强
蔡延深

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中文摘要:

目的　探讨上肢大面积皮肤撕脱伤反鼓取皮植皮术的临床效果。方法　回顾性分析2006 年4 月至2010 年6 月收治的9 例上肢大面积皮肤撕脱伤患者病历资料, 急诊行清创术, 将撕脱失去血供的皮肤软组织取下, 用鼓式取皮机修成中厚皮片后, 原位回植于创面, 术区分层包扎, 内层用阿米卡星盐水纱布、消毒绷带包扎, 外层用棉垫包扎, 术后悬吊, 避免局部受压, 术后3 d 更换外层敷料, 12 d 拆线。结果　9 例患者所植皮片95%以上成活, 局部小创面用湿润烧伤膏换药治疗后愈合, 均无需行二期手术治疗。术后行功能锻炼, 功能恢复良好。结论　反鼓取皮植皮是上肢大面积撕脱伤较理想的手术方式, 清创彻底, 止血充分, 包扎合理, 悬吊避免了创面过度受压, 有利于提高植皮成活率。

英文摘要:

Objective　To explore the effect of autologous skin transplantation with skin flap taken on reverse side using drum type dermatome in treating extensive skin avulsion of upper limbs. Methods　Retrospective analysis was conducted on 9 patients with extensive skin avulsion of the upper limbs admitted to our hospital from April 2006 to June 2010. All the patients underwent urgent debridement. The avulsed skin soft tissue deprived of blood supply was removed, shaved into medium split thickness skin flaps using drum type dermatome, and replanted them on the wound. Layering dressing was applied with Amikacin Saline gauzes as the inner layer, aseptic bandages in the middle and cotton pads as the outer layer. The injured extremities were suspended post operation to avoid local compression. The outer layer of dressing was changed 3 days post operation and the suture was removed 12 days post operation. Results　More than 95% of the transplant survived in the 9 cases. Sporadical small wounds healed with the dressing change of MEBO and no second operation was required. Function of the injured extremities restored sufficiently with exercise. Conclusion　Autologous skin transplantation with skin flap taken on reverse side using drum type dermatome is a relatively ideal surgical approach to treating extensive skin avulsion of upper limbs. Adequate debridement and hemostasis with appropriate dressing and overhanging to avoid compression can increase the survival rate of the transplant.