巫国庆 刘小飞 杨洋 陈然辰

[摘要]目的：探討扩创植皮术联合负压封闭引流（Vacuum sealing drainage，VSD）对足部皮肤撕脱伤的修复效果及对组织液CD11b、细胞间黏附分子-1（ICAM-1）的影响。方法：回顾性分析2018年1月-2019年12月笔者医院接诊的100例足部皮肤撕脱伤患者临床资料，通过治疗方式不同分为观察组和对照组，每组50例。两组入院后均接受急诊清创处理，对照组使用扩创植皮术联合常规加压包扎法治疗，观察组使用扩创植皮术联合VSD治疗。比较两组围术期情况、植皮成活率、组织液中CD11b及ICAM-1水平、并发症发生率。结果：观察组手术时间、住院时间、创面愈合时间分别为（99.84±6.50）min、（12.45±2.61）d、（13.83±2.09）d，均明显短于对照组的（114.39±6.71）min、（18.16±2.18）d、（19.67±2.40）d;换药次数为（2.64±0.37）次，明显少于对照组的（3.21±0.58）次;换药时视觉模拟评分法（Visual analogue scale，VAS）评分为（3.06±0.48）分，明显低于对照组的（4.31±0.73）分，差异均有统计学意义（P<0.05）。观察组植皮成活率为（95.34±3.84）%，明显高于对照组的（86.12±5.08）%，差异有统计学意义（P<0.05）。术后7d时，观察组组织液中CD11b、ICAM-1均明显低于对照组[（46.73±5.03）% vs （52.12±4.27）%，（284.15±20.64）ng/ml vs（336.36±24.21）ng/ml]，差异有统计学意义（P<0.05）。观察组感染、皮下血肿发生率分别为0.00%（0/50）和2.00%（1/50），明显低于对照组的10.00%（5/50）和14.00%（7/50），差异有统计学意义（P<0.05）;两组创面积液、创面溃烂、皮肤浸渍、皮片移位发生率比较差异无统计学意义（P>0.05）。结论：扩创植皮术联合VSD治疗足部皮肤撕脱伤效果显著，可有效促进创面愈合及植皮存活，值得应用推广。

[关键词]足部皮肤撕脱;扩创植皮术;负压封闭引流;加压包扎;感染;组织液

[中图分类号]R622    [文献标志码]A    [文章编号]1008-6455（2021）07-0029-04

Study on the Repair Effect of Augmented Skin Grafting Combined with VSD on Avulsion of Foot Skin

WU Guo-qing，LIU Xiao-fei，YANG Yang，CHEN Ran-chen

（Department of Burns and Plastic Surgery，909th Hospital of the Joint Logistics Support Unit of the Chinese People's Liberation Army，Zhangzhou 363000，Fujian，China）

Abstract： Objective  To study the effect of expanded skin grafting combined with vacuum sealing drainage（VSD） in treatment of foot skin avulsion and the influence on tissue fluid CD11b and intercellular adhesion molecule-1 （ICAM-1）. Methods  The clinical data of 100 cases with foot skin avulsion from January 2018 to December 2019 were analyzed retrospectively， according to the different treatment methods， they were divided into the observation group and the control group， 50 cases in each group. They were received emergency debridement after admission， the control group was treated with expanded skin grafting combined with conventional pressure bandage， while the observation group was treated with expanded skin grafting combined with VSD. The perioperative condition， the survival percentage of skin grafting， tissue fluid CD11b， ICAM-1 and the incidence of complications were compared between the two groups. Results  The operation time， hospitalization time and wound healing time in the observation group were （99.84±6.50）min， （12.45±2.61）d， （13.83±2.09）d， respectively， which were significantly shorter than the control group （114.39±6.71）min， （18.16±2.18）d， （19.67±2.40）d， the differences were statistically significant （P<0.05）. The dressing change times were （2.64±0.37）times， which were significantly less than the control group （3.21±0.58）times（P<0.05）. The VAS score in the dressing change were （3.06±0.48）scores， which were significantly lower than the control group （4.31±0.73）scores （P<0.05）. The survival percentage of skin grafting in the observation group were （95.34±3.84）%， which were significantly higher than the control group [（86.12±5.08）%， P<0.05]. After operation 7 days， CD11b and ICAM-1 in the observation group were significantly lower than those in the control group[（46.73±5.03）% vs （52.12±4.27）%， （284.15±20.64）ng/ml vs （336.36±24.21）ng/ml， P<0.05]. The incidence of infection and hematoma in the observation group were 0.00%（0/50） and 2.00%（1/50）， respectively， which was significantly lower than the control group 10.00% （5/50） and 14.00% （7/50）， the differences were statistically significant （P<0.05）. There was no significant difference in the incidence of wound area fluid， wound ulceration， skin immersion and skin flap displacement between the two groups （P>0.05）. Conclusion  Expanded skin grafting combined with VSD is well for foot skin avulsion， which can effectively promote wound healing and skin grafting survival ， it's worth popularizing.

Key words： foot skin avulsion; expanded skin grafting; vacuum sealing drainage; pressure bandage; infection; tissue fluid

随着机械工业的不断发展、交通事故的频发，足部砸压伤、碾压伤的发生率也有逐年增长的趋势，在此类损伤患者中不仅存在骨折，足部皮肤也会出现不同程度的撕脱伤，在所有的足部外伤中，足部皮肤撕脱伤所占比例约5.6%，不仅影响到恢复，也对患者的生活质量有着严重影响[1]。扩创植皮术是足部撕脱伤患者较为常用的修复方法，在恢复创面美观及功能方面有较好的作用，在术后处理方面，临床上多采用常规的打包加压法，但也存在着部分不足，例如受力不均匀、空隙较大等，在一定程度上也影响了术后恢复[2]。……