临床骨科杂志2024，Vol.27Issue(2) ：209-213.DOI:10.3969/j.issn.1008-0287.2024.02.017

全厚皮片回植治疗四肢累及关节大面积皮肤撕脱伤

Replantation of full-thickness skin graft for treatment of large area skin avulsion injury of ex-tremities involving joints

吴卫宾 杜云峰 王红星 张番
临床骨科杂志2024，Vol.27Issue(2) ：209-213.DOI:10.3969/j.issn.1008-0287.2024.02.017
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全厚皮片回植治疗四肢累及关节大面积皮肤撕脱伤

Replantation of full-thickness skin graft for treatment of large area skin avulsion injury of ex-tremities involving joints

吴卫宾 1杜云峰 1王红星 1张番1
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作者信息

  • 1. 焦作煤业(集团)有限责任公司中央医院骨二科,河南 焦作 454000
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摘要

目的 探讨全厚皮片回植治疗四肢累及关节大面积皮肤撕脱伤的疗效.方法 将15 例四肢累及关节大面积皮肤撕脱伤患者采用全厚皮片回植治疗.记录回植皮片成活情况.采用温哥华瘢痕量表(VSS)评分评价瘢痕外观情况,采用Highet评价系统评价感觉神经功能恢复情况.根据受累关节不同,分别采用膝关节HSS评分、AOFAS踝-后足评分、肘关节改良Cassebaum评分、腕关节Cooney评分评价关节功能.结果 患者均获得随访,时间1～5 年.① 术后1 个月回植皮片成活情况:优14 例,可1 例.② 术后1 年VSS评分评价瘢痕外观:满意11 例,尚可4 例.③术后1 年Highet评价系统评价感觉神经功能:S4 级5 例,S3 级9 例,S2级1 例.④ 术后1 年,9 例累及膝关节者HSS评分为优2 例、良5 例、可 1 例、差 1 例;2 例累及踝关节者中 1例AOFAS踝-后足评分为优,另1 例截肢;5 例累及肘关节者改良Cassebaum评分为优1 例、良3 例、可1 例;1 例累及腕关节者Cooney评分为良.结论 全厚皮片回植治疗四肢累及关节大面积皮肤撕脱伤,方法简便易行且皮片成活率高,在外观、感觉恢复方面都能取得满意疗效,待皮片成活后早期配合功能锻炼可促进患者关节功能的恢复.

Abstract

Objective To explore the clinical efficacy of replantation of full-thickness skin graft for treatment of large area skin avulsion injury of extremities involving joints.Methods Fifteen patients with extensive skin avulsion of ex-tremities involving joints were treated with full-thickness skin graft.The survival of replanted skin graft was recorded.The scar appearance was assessed with the Vancouver Scar Scale(VSS),and neurosensory function recovery were e-valuated by Highet evaluation system.According to the different joints involved,the joint function was evaluated by knee joint HSS score,AOFAS ankle-hindfoot score,elbow modified Cassebaum score and wrist Cooney score.Results All patients were followed up for 1～5 years.①Survival condition of full-thickness replanted skin graft at 1 month after operation:excellent in 14 cases and fair in 1 case.②The scar appearance was assessed with VSS at 1 year after operation:satisfactory in 11 cases,fair in 4 cases.③At 1 year after operation,the neurosensory function assessed with Highet evaluation system:grade S4 in 5 cases,grade S3 in 9 cases,grade S2 in 1 case.④At postoperative 1 year,HSS scores of 9 cases involving knee joints were excellent in 2 cases,good in 5 cases,fair in 1 case and poor 1 case;in the 2 cases involving ankle joint,1 case was excellent by AOFAS ankle-hindfoot score,and 1 case was amputated;the 5 cases with elbow joint involvement were assessed with the modified Cassebaum score,the results were excellent in 1 case,good in 3,and fair in 1;the 1 case with wrist joint involvement was good by Cooney score.Conclusions Re-plantation of full-thickness skin graft for the treatment of large area skin avulsion of joints involved in extremities is a simple and easy method with a high survival rate,and satisfactory results can be achieved in appearance and sensa-tion.Early functional exercise after skin graft survival can promote the recovery of joint function.

关键词

大面积皮肤撕脱伤/累及关节/全厚皮片/回植/负压封闭吸引技术

Key words

large area skin avulsion injuries/involving joint/full-thickness skin graft/replantation/vacuum sealing drainage

引用本文复制引用

出版年

2024
临床骨科杂志
安徽医科大学，安徽省医学会

临床骨科杂志

CSTPCD
影响因子：1.438
ISSN：1008-0287
参考文献量15
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