天津医药

天津医药 ›› 2018, Vol. 46 ›› Issue (2): 191-194.doi: 10.11958/20171107

• 临床研究 • 上一篇    下一篇

简易外部皮肤扩张术治疗Pilon骨折术后皮肤坏死缺损

赵士君， 燕冰， 王爱国△   

  1. 郑州市骨科医院创伤骨科 （邮编450052）
  • 收稿日期:2017-10-18 修回日期:2017-12-30 出版日期:2018-02-15 发布日期:2018-02-15
  • 通讯作者: 王爱国 E-mail:shijun2009@aliyun.com

Simple external skin expansion technique in treatment of skin necrosis defect after the surgery for Pilon fracture

ZHAO Shi-jun， YAN Bing， WANG Ai-guo△   

  1. Department of Orthopedic Trauma， Zhengzhou Orthopedics Hospital， Zhengzhou 450052， China
  • Received:2017-10-18 Revised:2017-12-30 Published:2018-02-15 Online:2018-02-15

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摘要： 摘要： 目的 探讨简易外部皮肤扩张术在治疗 Pilon 骨折术后皮肤坏死中的价值。方法 回顾性分析 2015 年 5 月—2017 年 1 月采用简易外部皮肤扩张术治疗的 12 例 Pilon 骨折术后皮肤坏死缺损患者资料。其中男 10 例， 女 2 例； 年龄 32~58 岁， 平均 （45.30±8.91） 岁； 开放性骨折 4 例， 闭合性骨折 8 例； 缺损部位长约 9.1 cm、 宽约 3.9 cm； 3 例为开放性骨折部位皮肤坏死， 9 例为术后手术切口部位皮肤坏死。皮肤坏死部位彻底清创排除感染后， 克氏针间断穿过皮肤， 在克氏针两端各绕一个无菌橡胶管与对侧创缘的克氏针两端相连接， 给予适度拉力， 拉力大小以两侧皮缘仍有渗血、 皮肤颜色无明显苍白为度， 两端橡胶管以止血钳固定。利用皮肤的延展性和橡胶管的拉力作用使皮肤逐渐延伸， 逐渐缩小并缝合创面。所有患者术后随访 3~6 个月， 观察手术疗效。结果 术后 12 例患者创面均愈合，愈合时间为 2~4 周， 平均 （2.50±0.59） 周。12 例患者全部牵张成功后直接间断缝合， 其中 4 例患者因在外露内置物或肌腱表面牵张缝合， 致使部分牵张皮肤延迟愈合， 再次缝合后愈合。牵张后的皮肤色泽正常、 毛发生长正常、 弹性良好、 无臃肿且触痛觉正常。结论 简易外部皮肤扩张术治疗 Pilon 骨折术后皮肤坏死缺损是一种简单、 有效、 经济的方法， 值得临床推广。

关键词: 关键词： 骨折, 开放性, 组织扩张, 简易外部皮肤扩张术, Pilon 骨折, 皮肤坏死缺损

Abstract: Abstract: Objective To evaluate the clinical effects of simple external skin expansion technique in treatment of skin necrosis defect after the surgery for Pilon fracture. Methods Data of 12 patients with skin necrosis defect after the surgery for Pilon fracture treated with simple external skin expansion technique in our hospital from May 2015 to January 2017 were retrospectively analyzed. There were 10 males and 2 females in the 12 patients with age 32-58 years old (average 45.30± 8.91 years old). There were 4 cases with open fractures and 8 cases with closed fractures. The defect area was about 9.1 cm long and 3.9 cm wide. There were 3 cases with skin necrosis of open fractures and 9 cases with postoperative skin necrosis of incision site. After completely debridement and removing infection from the skin necrosis areas, kirschner needle wired intermittented through the skin, the kirschner wire was around a sterile silicone rubber tube at both ends and the kirschner wire was connected to the both ends of the Kirschner on the opposite side. After giving moderate tensile force, which showed that the skin on both sides was still bleeding, no obvious pale color on skin, two ends of rubber tube were fixed with forceps. Using the ductility of skin and the tensile force of sterile silicone rubber tube to gradually extend the skin and to gradually narrow and close the suturing wound. All patients were followed up for 3-6 months to observe the effect of surgery. Results All of the 12 cases were healed in 2-4 weeks, average (2.50±0.59) weeks. The patients were sutured directly after simple external skin expansion, and 4 patients were sutured with the surface of the external plate or tendon, and parts of wound were delayed healed after the re-suture. The skin color, lustre, hair growth and elasticity were normal, no bloated, and tenderness was normal after simple external skin expansion. Conclusion The simple external skin expansion technique in treatment of skin necrosis defect after the surgery for Pilon fracture is a simple, effective and economic method, which is worthy of clinical promotion.

Key words: Key words: fractures, open, tissue expansion, simple external skin expansion technique, Pilon fractures, skin necrosis defect