跟腱外露難愈創(chuàng)面的封閉式負壓吸引治療

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1、跟腱外露難愈創(chuàng)面的封閉式負壓吸引治療跟腱外露難愈創(chuàng)面的封閉式負壓吸引治療［摘要］目的：總結(jié)封閉式負壓引流(vacuum-assistedclosure,VAC)技術治療跟腱外露創(chuàng)面的良好效果，為這類創(chuàng)面修復提供更好的治療方法。方法：2007年1月?2014年3月，筆者應用VAC治療18例跟腱外露患者，其中跟腱斷裂術后9例，車禍傷4例，重物卡壓傷2例，鋼繩切割傷1例，III度燒傷1例，III度電擊傷1例。圍手術期準備后，盡快手術擴創(chuàng)，行創(chuàng)面VAC治療。結(jié)果：所有創(chuàng)面經(jīng)VAC治療后，創(chuàng)面明顯縮小，肉芽生長迅速，部分或全部覆蓋外露肌腱，其中12例全部被肉芽組織覆蓋，

2、行薄中厚皮片移植修復，11例患者一期愈合。余仍有部分肌腱外露者，5例行鄰近皮瓣修復，全部一期愈合；1例行人工真皮加自體刃厚皮片移植一次性修復，所有創(chuàng)面一期愈合率達94.4%o所有患者均隨訪6月?3年，無復發(fā)，局部無攣縮，功能恢復良好。結(jié)論：VAC治療跟腱外露難愈創(chuàng)面，明顯縮短療程，有效防治肌腱壞死，減少手術創(chuàng)傷及治療疼痛，提高愈合質(zhì)量。［關鍵詞］封閉式負壓引流；跟腱；創(chuàng)面；肉芽組織［中圖分類號1R622［文獻標識碼］A［文章編號:1008-6455(2014)14-1139-04Vacuum-assistedclosuretreatmentofachilles

3、tendonexposedrefractorywoundsLIUFei,ZHANGChen-wei,LINHai-bo,GUOZheng-dong,WangYan,HONGHao,LUOKai,QINWang-chi,YANGWei-guo,LIANGZhi(DepartmentofPlasticandCosmeticSurgery,NanshanAffiliatedHospitalofGuangDongMedicalCollege,Shenzhen518052,Guangdong,China)Abstract：ObjectiveTosummarizether

4、esultofvacuum-assistedclosure(VAC)treatmentofAchillestendonexposedrefractorywounds,andprovidedabettermethodtotreatthesewounds?MethodsEighteenpatientswithAchillestendonexposedrefractorywounds,hospitalizedfromJanuary2007toMarch2014,weretreatedwithVAC?Thetendonofpostoperativewoundinfec

5、tionofskinsofttissuenecrosis(9cases),caraccidentinjuryskinandsofttissuedefect(4cases),heavyconformityofskinsofttissuenecrosis(2cases),steelcordcuttinginjuryskinandsofttissuedefect(2cases),third-degreeburn(1cases),third-degreeelectricalinjury(leases)?Allthepatientsweregivensystemicsu

6、pportingtreatmentinperioperativeperiodandearlydebridement,andweretreatedwithVAC?ResultsAfterVACtreatment,allwoundssignificantlyreduced,thefreshgranulationtissueformedrapidlyinallcases,someorallofthecoveringexposedtendons,12patientswereallcoveredwithgranulationtissueexposedtendons?12

7、caseswiththinthicknessskingrafttorepair,11patientswereprimaryhealing；5patientswithadjacentflaprepair,allpatientswereprimaryhealing；1patientswithartificialdermisandautologoussplit-thicknessskingraftone-timerepair,allwoundprimaryhealingratewas94.4%.Allpatientswerefollowedupfor6monthst

8、o3years,norecurrenc