[摘要]目的：探討负压封闭引流技术（Vacuum sealing drainage，VSD）结合游离植皮治疗儿童下肢大面积皮肤缺损疗效，并对影响患儿生活质量的因素进行分析。方法：选取2014年1月-2019年1月笔者医院收治的下肢大面积皮肤缺损患儿95例，按照自愿原则与随机数表法分为观察组和对照组，对照组30例患儿采用游离植皮术治疗，观察组65例患儿在对照组的基础上结合VSD治疗。比较两组患儿的皮片成活时间、皮片成活率、换药次数、住院天数和生活质量，采用多因素Logistics回归法分析可能影响VSD结合游离植皮治疗患儿生活质量的相关因素。结果：观察组患儿皮片成活时间、换药次数与住院天数均小于对照组，皮片成活率大于对照组，差异有统计学意义（P<0.05）。治疗后，观察组患儿的活动能力、心理健康、社交能力和生活质量总平均分均高于对照组，差异有统计学意义（P<0.05）。Logistics回归分析结果显示，皮肤受损面积、疼痛、焦虑和术后并发症是患儿生活质量的影响因素（P<0.05）。结论：VSD结合游离植皮治疗儿童下肢大面积皮肤缺损疗效显著，有助于改善患儿的生活质量，皮肤受损面积、疼痛、焦虑、术后并发症是影响患儿接受VSD结合游离植皮治疗后生活质量的相关因素。

[关键词]负压封闭引流技术;游离植皮;儿童;下肢皮肤缺损;生活质量;影响因素

[中图分类号]R622    [文献标志码]A    [文章编号]1008-6455（2021）01-0042-04

VSD Combined with Free Skin Graft in the Treatment of Large Area Skin Defect of Lower Limbs in Children

ZHANG Xiong

（Department of Orthopedics，the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine，Changsha 410007，Hunan，China）

Abstract： Objective  To explore the curative effect of vacuum sealing drainage （VSD） combined with free skin graft on children with lower limb large-area skin defects， and analyze the factors influencing their quality of life. Methods  95 children with lower limb large-area skin defects who were admitted to the hospital between January 2014 and January 2019 were enrolled in the study. They were divided into the observation group and the control group by the random number table method. 30 children in the control group were treated with free skin graft， and 65 children in the observation group were treated with VSD on basis of the treatment for control group. The survival time and survival rate of skin grafts， frequency of dressing change， hospital stay and quality of life were compared between the two groups. Multivariate Logistic regression analysis was conducted to analyze the related factors that might influence quality of life of children in the observation group. Results  The survival time of skin grafts， frequency of dressing change and hospital stay of observation group were shorter and lower than those of control group， the differences were statistically significant （P<0.05）. The survival rate of skin grafts was higher than that in control group （P<0.05）. After treatment， the observation group had higher scores for activities， mental health， social function and total quality of life score than the control group （P<0.05）. Logistic regression analysis showed that area of damaged skin， pain， anxiety and postoperative complications were factors influencing quality of life of children （P<0.05）. Conclusion  VSD combined with free skin graft is markedly effective in the treatment of children with lower limb large-area skin defects. It is conducive to improving quality of life of children. The area of damaged skin， pain， anxiety and postoperative complications are factors influencing quality of life of children receiving VSD and free skin graft.

Key words： vacuum sealing drainage; free skin graft; children; skin defect of lower limbs; quality of life; influencing factors

下肢皮肤大面积缺损是临床上儿童较为常见的外科问题，引起下肢皮肤大面积缺损的因素较多，其临床特点为皮肤撕裂、皮下结缔组织撕脱，严重者神经、肌腱及骨关节折损裸露[1]。传统的游离植皮术是儿童下肢皮肤大面积缺损的常用治疗手段，但操作难度较大，易引起术后植皮感染、坏死，手术效果难以保障[2]。负压封闭引流技术（Vacuum sealing drainage，VSD）作为一种新型技术，能以特制敷料将创面覆盖，通过负压装置进行引流，使创面在负压环境下进行治疗，达到降低感染的目的[3]。本研究旨在探讨VSD结合游离植皮治疗儿童下肢大面积皮肤缺损疗效及对患儿生活质量的影响，取得了良好效果，现报道如下。……