摘要
目的 探讨胸大肌肌瓣联合负压灌洗一期修复开胸术后难愈性伤口的治疗效果.方法 回顾性选取 2020 年 1 月至 2023 年 1月空军军医大学第一附属医院收治的开胸术后难愈性伤口患者21例,其中男16例,女5例,年龄35～75岁,平均(62.2±11.3)岁,创面面积6cm×3cm～25cm×5cm.手术去除感染胸骨,根据残腔部位及大小,游离伤口两侧相应节段的胸大肌予以缝合填塞.肌瓣下方预留灌洗管.待肌瓣覆盖残腔后,创面周围皮肤无张力拉拢缝合,并以-30～-20kPa 的负压吸引.术后第 1 天开始,使用生理盐水灌洗,每日 2000ml.观察灌洗液的性状、颜色、量及患者全身症状,待灌洗液清亮后拔管并拆除负压装置,创面隔天换药 1 次,术后 2 周拆线.结果 19 例患者在术后 14d内一期愈合,2 例患者遗留散在约 1cm×1cm大小的创面,继续换药,术后 1 个月均愈合.随访 0.5～2 年,患者胸廓外形美观,前部躯体及上肢活动无影响,上肢肌力无明显改变.结论 针对开胸术后难愈性伤口,在去除感染胸骨后,通过胸大肌肌瓣联合负压灌洗一期封闭创面,可降低伤口感染及患者死亡风险,缩短患者住院时间,手术操作简单,对患者创伤较小.
Abstract
Objective To investigate the therapeutic effect of pectoralis major muscle flap combined with negative pressure lavage in one-stage repair of refractory wounds after thoracotomy.Methods From January 2020 to January 2023,21 patients with refractory wounds after thoracotomy were retrospectively selected from the First Affiliated Hospital of Air Force Military Medical University,including 16 males and 5 females,aged 35 to 75 years old,with an average age of(62.2±11.3)years old.The wound area was 6cm×3cm to 25cm×5cm.The infected sternum was removed.According to the location and size of the residual cavity,the pectoralis major muscle of the corresponding segment on both sides of the free wound was sutured and filled.The irrigation tube was reserved below the muscle flap.After the muscle flap covered the residual cavity,the skin around the wound was sutured without tension,and the negative pressure suction of-30 to-20 kPa was given.From the first day after operation,physiological saline was used for lavage,2000ml per day.The character,color and amount of lavage fluid and the systemic symptoms of patients were observed.After the lavage fluid was clear,the tube and the negative pressure device were removed.The wound was changed once every other day,and the stitches were removed 2 weeks after operation.Results Nineteen patients achieved primary healing within 14 days after operation.Two patients had scattered wounds of about 1 cm×1 cm in size,and continued dressing change.All patients healed one month after operation.The patients were followed up for half a year to 2 years.The patient's chest shape was beautiful.There was no effect on the activity of the forebody and upper limbs,and there was no significant change in the muscle strength of the upper limbs.Conclusion For the refractory wounds after thoracotomy,after removing the infected sternum,using the pectoralis major muscle flap combined with negative pressure lavage to close the wound in one stage can reduce the risk of wound infection and death,shorten the hospital stay of patients,and the operation is simple and the trauma to patients is less.
国家科技期刊平台
NSTL
维普
万方数据