Department of Surgery, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA.
Surg Clin North Am. 2010 Dec;90(6):1181-94. doi: 10.1016/j.suc.2010.08.001.
Complex wounds present a challenge to both the surgeon and patient in operative management, long-term care, cosmetic outcome, and effects on lifestyle, self-image, and general health. Each patient with complex wounds usually manifests multiple risk factors for their development. This article focuses on complex wounds involved with traumatic and orthopedic blunt or penetrating injuries, particularly in the extremities, as well as massive soft tissue infections including necrotizing fasciitis, gas gangrene, and Fournier gangrene. The principles of management of complex wounds involve assessing the patient's clinical status and the wound itself, appropriate timing of intervention, providing antibiotic therapy when necessary, and planning and executing surgical therapy, including the establishment of a clean wound bed and closure/reconstructive strategies.
复杂伤口对手术治疗、长期护理、美容效果以及对生活方式、自我形象和整体健康的影响都提出了挑战。每个患有复杂伤口的患者通常都表现出多种导致其发生的风险因素。本文主要关注涉及创伤和骨科钝器或穿透性损伤的复杂伤口，特别是四肢，以及包括坏死性筋膜炎、气性坏疽和 Fournier 坏疽在内的大面积软组织感染。复杂伤口处理的原则包括评估患者的临床状况和伤口本身，适当的干预时机，在必要时提供抗生素治疗，以及规划和执行手术治疗，包括建立清洁的创床和闭合/重建策略。
