医用胶原蛋白海绵及负压封闭引流联合自体刃厚皮复合移植在足部毁损伤难愈性创面中的应用

doi:10.3877/cma.j.issn.1673-9450.2021.02.005

目的

观察医用胶原蛋白海绵及负压封闭引流(VSD)联合自体刃厚皮复合移植修复足部毁损伤难愈性创面的效果。

方法

选取2017年1月至2019年10月海南省人民医院烧伤与皮肤修复外科收治的足部毁损伤难愈性创面患者18例，其中合并足背肌腱外露12例，跖骨骨外露6例。创面清创后，予医用胶原蛋白海绵覆盖肌腱外露、骨外露创面，并安装VSD装置，待创面覆盖肉芽组织后，再给予自体刃厚皮移植修复创面。记录治疗时间、外露肌腱或骨质坏死率、皮片成活率，术后随访6个月，以Maryland足部功能评分标准评估外观及功能。

结果

18例患者足部均得以保存，外露的肌腱和骨质均保持活性，皮片成活率85%～95%，平均(90±5)% 。残余创面给予间断换药治疗后全部愈合，治疗时长14.0～45.0 d，平均(29.5±15.5) d。出院后6个月复诊以Maryland足部功能评分标准评估足部功能，优3例，良4例，中6例，差5例。

结论

医用胶原蛋白海绵及VSD在促进肌腱、骨质外露创面肉芽组织生长的同时可保留外露的肌腱及骨组织活性，联合自体刃厚皮移植，能较好地修复足部毁损伤难愈性创面。

关键词: 负压伤口疗法, 皮肤移植, 伤口愈合, 医用胶原蛋白海绵, 难愈性创面

Objective

To observe the effect of medical collagen sponge and vacuum sealing drainage (VSD) combined with autologous epidermal skin graft in the treament of refractory wound of foot destructive injury.

Methods

From January 2017 to October 2019, 18 patients with refractory wounds after foot destructive injury were treated in Department of Burns and Wound Repair Surgery, Hainan Provincial People′s Hospital, including 12 cases with dorsal tendon of foot exposure, 6 cases with metatarsal bone exposure. After debridement, collagen sponge was given to cover the tendon exposed and bone exposed wound, and VSD device was installed. When granulation tissue cover the wound, the autologous epidermal skin was grafted on. The duration of treatment, the rate of necrosis of exposed tendon or bone and the survival rate of epidermal skin were recorded. All patients were followed up for 6 months. The appearance and function of patients were evaluated after the treatment.

Results

The feet of 18 patients were preserved. The exposed tendons and bones remained activity. Survival rate of epidermal skin was 85%-95%, average(90±5)%. All residual wounds healed after intermittent dressing change. The duration of treatment were 14.0-45.0 d, average(29.5±15.5) d. The foot function was assessed by Maryland foot function score in 6th month after discharge, excellent in 3 cases, good in 4 cases, moderate in 6 cases and poor in 5 cases.

Conclusion

Medical collagen sponge and VSD can promote the growth of granulation tissue in the wound with exposed tendon or bone, and meanwhile retentive their activity, which can repair the refractory wound of foot destructive injury combined with autologous epidermal skin graft.

Key words: Negative pressure wound therapy, Skin transplantation, Wound healing, Medical collagen sponge, Refractory wound

图1 应用医用胶原蛋白海绵及VSD联合自体刃厚皮移植修复右足中远端严重毁损。A示患者第3趾自跖趾关节离断，第3跖骨粉碎性骨折，第2跖骨外露，大片足背皮肤缺损；B示清创后以医用胶原蛋白海绵覆盖外露骨质，外用VSD覆盖并冲洗治疗；C、D、E示3个疗程后拆除VSD装置见创面清洁，第2跖骨完全被肉芽组织覆盖；F示伤后28 d取患者右大腿刃厚皮移植于足部肉芽组织创面；G示8 d后皮肤大部分成活；VSD为负压封闭引流

图2 应用医用胶原蛋白海绵及VSD联合自体刃厚皮移植修复左足广泛皮肤撕脱，肌腱、足趾骨质外露。A示皮肤原位缝合伤后6 d足趾及皮肤颜色发暗，皮肤坏死；B示伤后10 d行清创术，去除坏死皮肤及软组织，足背多发肌腱外露；C示以医用胶原蛋白海绵覆盖外露的肌腱(图2C)；D示安装VSD装置治疗3周；E示于患者左大腿取刃厚皮移植于左足肉芽创面；F示术后8 d皮肤完全成活；VSD为负压封闭引流

图3 应用医用胶原蛋白海绵及VSD联合自体刃厚皮移植修复右足背大片皮肤撕脱并趾离断，肌腱、跖骨外露。A示右足第2、3、4趾缺血性坏疽；B示伤后8 d，急诊行手术清创、截趾；C示以医用胶原蛋白海绵覆盖外露的肌腱和跖骨；D示医用胶原蛋白海绵联合VSD治疗2周后创面肉芽组织生长良好，覆盖外露的肌腱和骨质；E示伤后22 d取患者右大腿刃厚皮片移植于右足创面；F示残余创面经保守换药痊愈；VSD为负压封闭引流

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Application of medical collagen sponge and vacuum sealing drainage combined with autologous epidermal skin graft in the refractory wound of foot destructive injury

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Application of medical collagen sponge and vacuum sealing drainage combined with autologous epidermal skin graft in the refractory wound of foot destructive injury