四肢皮肤逆行撕脱伤是比较严重的损伤,在临床上比较多见且治疗困难。皮肤逆行撕脱伤是机械及其他的外力作用导致皮肤和皮下组织从深筋膜浅面强行撕脱,同时可能伴有不同程度的软组织碾压伤。受伤原因多见于压面机碾压、机器绞伤、机器牵拉、手动器械挫伤等。比如手外科常见为手背皮肤逆行撕脱,通常连同手背静脉网,以及伸肌腱腱周膜浅层,甚至连同伸肌腱一同逆行撕脱,此种情况临床上较为常见,治疗起来颇为棘手,损伤较重者往往会发生软组织坏死,甚至会导致功能丧失。如何正确处理皮肤撕脱皮肤,是严重创伤诊治中经常遇到的难题。现将各种治疗方案进行对比,为临床治疗提供更为准确的思路。 Retrograde avulsion of the limb skin is a more serious injury, which is common in clinic and dif-ficult to treat. Retrograde avulsion of the skin is caused by mechanical and other external forces that force the skin and subcutaneous tissue to avulsion from the superficial surface of deep fas-cia, and may be accompanied by different degrees of soft tissue crushing injury. The cause of in-jury is more in the face press, machine wound, machine pull, and manual instrument contusion. For example, in hand surgery, retrograde avulsion of dorsal hand skin is common, which is usu-ally accompanied by dorsal hand vein network, superficial layer of extensor tendon peritendi-nous membrane, and even retrograde avulsion of extensor tendon. This situation is relatively common in clinical practice and difficult to treat. How to treat skin avulsion correctly is a com-mon problem in the diagnosis and treatment of severe trauma. Now the various treatment plans are compared to provide more accurate ideas for clinical treatment.
李修国,刘永涛. 四肢皮肤逆行撕脱伤治疗方案及创面处理 The Treatment of Retrograde Avulsion Injury of Extremities Skin and Wound Covering[J]. 外科, 2020, 09(02): 34-41. https://doi.org/10.12677/HJS.2020.92006
参考文献References肖贵喜, 于冶, 包亚明, 等. 不同程度皮肤撕脱伤38例的治疗分析[J]. 中华损伤与修复杂志, 2012, 7(6): 651-653.赵建宏. 足背皮肤逆行撕脱伤144例治疗分析[J]. 南通医学院校报, 1996, 16(3): 399 + 402.黄俊, 牛磊. 大面积逆行性皮肤软组织撕脱伤重建静脉回流的临床疗效[J]. 临床骨科杂志, 2018, 21(1): 70-72.Leland, H.A., Rounds, A.D., Burtt, K.E., et al. (2018) Soft Tissue Reconstruction and Salvage of In-fected Fixation Hardware in Lower Extremity Trauma. Microsurgery, 38, 259-263. <br>https://doi.org/ 10.1002/micr.30176李传满, 李永盛. 全层筛孔状皮片再植治疗大面积撕脱伤16例报告[J]. 修复重建外科杂志, 1989, 3(2): 96.唐贇章, 徐永年, 陈庄洪, 等. 全厚皮片原位植皮治疗下肢大面积撕脱伤[J]. 实用骨科杂志, 1996, 2(4): 223-224.Jeng, S.F., Hsieh, C.H., Kuo, Y.R., et al. (2004) Technical Refinement in the Management of Circumferentially Avulsed Skin of the Leg. Plastic and Reconstructive Surgery, 114, 1225-1227.
<br>https://doi.org/ 10.1097/01.PRS.0000135869.57955.35李巨涛. 原位超薄皮瓣及皮片回植结合VSD治疗手背皮肤逆行撕脱伤的效果分析[J]. 中国医药指南, 2018, 16(28): 75-76.Vloemans, A.F., Schreinema-chers, M.C., Middelkoop, E., et al. (2002) The Use of Glycerol-Preserved Allografts in the Beverwijk Bun Centre: A Retrospective Study. Bums: Journal of the International Society for Burn Injuries, 28, 2-9. <br>https://doi.org/ 10.1016/S0305-4179(02)00084-0周望高, 叶学浪, 余少校, 等. 原位植皮结合负压封闭引流治疗无血管吻合的手掌皮肤逆行撕脱伤[J]. 海南医学, 2020, 31(1): 51-54.郭宗慧, 余霄, 唐寅, 等. 真皮下血管网层反取皮回植联合负压封闭引流在下肢大面积皮肤撕脱伤中的应用[J]. 中国骨伤, 2019, 32(6): 569-573.魏长月, 郭德亮 , 范启申. 吻合静脉的撕脱皮瓣原位缝合修复手背皮肤逆行撕脱伤[J]. 中华手外科杂志, 1998, 14(2): 72-73.宋坤修, 马丙栋, 刘永涛. 吻合回流静脉对手部皮肤逆行撕脱伤成活的影响[J]. 实用手外科杂志, 2018, 32(1): 102-103.吕少威, 徐少宏, 郭子诚, 等. 足跟皮肤撕脱伤早期合理干预对患者预后的影响[J]. 中国现代医药杂志, 2020, 22(1): 42-43.Miyamoto, S., Arikawa, M., Kagaya, Y., et al. (2020) Large-to-Small End-to-Side Venous Anastomosis in Free Flap Transfer. Journal of Surgical Research, 245, 377-382. <br>https://doi.org/ 10.1016/j.jss.2019.07.084梁炳生, 裴连魁, 马迅. 动静脉转流组织移(再)植的研究[J]. 实用骨科杂志, 1994, 24(1): 1-3.赵巨伟, 周庆文, 何凯, 等. 动静脉转流术治疗手背皮肤逆行撕脱伤[J]. 实用骨科杂志, 2010, 16(9): 64-685.Lee, M., Lee, Y.K. and Kim, D.H. (2019) The Clinical Result of Arte-rialized Venous Free Flaps for the Treatment of Soft Tissue Defect of the Fingers. Medicine, 98, e16017. <br>https://doi.org/ 10.1097/MD.0000000000016017陈靖, 陈情忠, 李双, 等. 改良动脉化静脉皮瓣修复手指软组织缺损[J]. 中国修复重建外科杂志, 2019, 33(4): 475-478.Li, Z., Zhang, Z.H., Yu, S.X., et al. (2018) The Experimental Study of Shunt-Decompression Arterialized Vein Flap. Cancer Cell International, 18, 148. <br>https://doi.org/ 10.1186/s12935-018-0622-z郭春, 蔚凡, 陈路. 三种腹部皮瓣修复手指软组织缺损的疗效[J]. 实用手外科杂志, 2004, 18(3): 148-149.Acharya, A.M., Ravikiran, N., Jayakrishnan, K.N., et al. (2019) The Role of Pedicled Abdominal Flaps in Hand and Forearm Composite Tissue Injuries: Results of Technical Refinements for Safe Harvest. Journal of Orthopaedics, 16, 369-376. <br>https://doi.org/ 10.1016/j.jor.2019.04.008侯春林, 顾玉东. 皮瓣外科学[M]. 上海: 上海科学技术出版社, 2006: 9 + 695-605.Elshahat, A. (2010) Management of Complex Avulsion Injuries of the Dorsum of the Foot and Ankle in Pediatric Patients by Using Local Delayed Flaps and Skin Grafts. Eplasty, 10, 534-540.Bali, Z.U., Evrenos, M.K., Karatan, B., et al. (2020) An Effective Technique for Managing Vascular Diameter Discrepancies in Micro-surgery: Tapering with a Hemoclip. Journal of Plastic Surgery and Hand Surgery, 54, 19-23.
<br>https://doi.org/ 10.1080/2000656X.2019.1657435Wang, J.C. and To, E.W. (2000) Application of Dermal Substitute (Integra) to Donor Site Defect of Forehead Flap. British Journal of Plastic Surgery, 53, 70-72. <br>https://doi.org/ 10.1054/bjps.1999.3201Wolter, T.P., Noah, E.M. and Pallua, N. (2005) The Use of Integra in an Upper Extremity Avulsion Injury. British Journal of Plastic Surgery, 58, 416-418. <br>https://doi.org/ 10.1016/j.bjps.2004.04.008Herlin, C., Louhaem, D., Bigorre, M., et al. (2007) Use of Integra in a Paediatric Upper Extremity Degloving Injury. Journal of Hand Surgery (European Volume), 32, 179-184. <br>https://doi.org/ 10.1016/J.JHSB.2006.11.013Demiri, E., Papaconstantinou, A., Dionyssiou, D., et al. (2013) Reconstruction of Skin Avulsion Injuries of the Upper Extremity with Integra Dermal Regeneration Template and Skin Grafts in a Single-Stage Procedure. Archives of Orthopaedic and Trauma Surgery, 133, 1521-1526. <br>https://doi.org/ 10.1007/s00402-013-1834-2Duteille, F., Perrot, P., Pannier, M., et al. (2004) Evaluation of the Advantages of Integra for Covering Chinese Flap Graft Donor Sites: A Series of 10 Cases. Plastic and Reconstructive Surgery, 114, 264-266.
<br>https://doi.org/ 10.1097/01.PRS.0000127237.37927.5E韩智强, 王淼, 周斌强. 显微外科手术治疗手部皮肤逆行撕脱伤的疗效[J]. 临床医药文献电子杂志, 2019, 6(16): 32.陈贤明, 张森, 王子明. 手部皮肤逆行套状撕脱伤的显微修复临床研究——评《四肢显微修复外科学》[J]. 电子显微学报, 2019, 38(5): 169.