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目的探讨应用负压封闭引流技术(VSD)联合外踝上皮瓣修复儿童足部软组织缺损创面的临床效果。方法选取2008年3月至2015年3月收治的74例儿童足部软组织缺损伴感染患者,其中40例创面清创VSD治疗后应用外踝上皮瓣修复缺损;34例常规换药,待创面新鲜、感染控制后外踝上皮瓣修复缺损。观察两种治疗方案创面感染情况、皮瓣成活情况、切口愈合时间、住院时间、术后随访瘢痕增生、功能状况。结果经VSD或改良VSD治疗1~2周后,创面感染率明显降低,肉芽组织新鲜;行外踝上皮瓣修复术,仅6例出现远端少量坏死,无皮瓣下感染及液化,经换药后愈合,与常规换药相比创面感染率低(P<0.05)、皮瓣成活率高(P<0.05)、切口愈合时间平均缩短1周、住院时间平均缩短2周,术后随访3~6个月,皮瓣外形、瘢痕增生情况与保守换药治疗比较差异有统计学意义(P<0.05),足部功能影响比较差异未见统计学意义(P>0.05)。结论 VSD较常规换药能有效地应用于复杂创面,有助于控制感染,刺激肉芽组织生长,为皮瓣移植提供良好条件,促进创面早期修复,缩短住院时间,降低住院费用;外踝上皮瓣解剖位置恒定,切取范围大,简便易行,成活率高,二者联合应用是修复儿童足部软组织缺损创面的有效方法。
Objective To investigate the clinical effect of subcutaneous closed drainage (VSD) combined with lateral malleolus flap in repair of pedicle soft tissue defect in children. Methods From March 2008 to March 2015, 74 children with soft tissue defect of foot and pediatric infection were selected. 40 cases were treated by debridement of lateral malleolus flap with debridement of VSD after wound debridement. 34 cases were given dressing and the wounds were fresh , Infection control lateral malleolus flap repair defect. The wound infection, flap survival, incision healing time, length of stay, postoperative scar proliferation and functional status were observed. Results After VSD or modified VSD for 1 to 2 weeks, the wound infection rate was significantly decreased and the granulation tissue was fresh. Only 6 cases had distal small necrosis, no subcutaneous flap infection and liquefaction after the lateral malleolus flap repair. Compared with conventional dressing, wound healing rate was lower (P <0.05), skin flap survival rate was higher (P <0.05), incision healing time was shortened by 1 week, hospitalization time was shortened by 2 weeks on average, and postoperative follow-up was 3 ~ 6 months, there was a significant difference in skin shape, scar hyperplasia and conservative dressing change (P <0.05), but there was no significant difference in foot function (P> 0.05). CONCLUSION VSD can be applied to complicated wounds more effectively than conventional dressing, which can help control infection and stimulate the growth of granulation tissue, provide good conditions for skin flap transplantation, promote early wound repair, shorten the hospitalization time and reduce hospitalization cost. The lateral malleolus flap Anatomical location, cutting a large area, simple and easy to operate, high survival rate, the combination of the two is an effective method to repair soft tissue defects in children’s feet.