Albu E, Alexandru A, Marinescu B, Ene R, Cârstoiu C
"Carol Davila" University of Medicine and Pharmacy; Clinic of Plastic Surgery and Reconstructive Microsurgery, University Emergency Hospital, Bucharest, Romania.
"Carol Davila" University of Medicine and Pharmacy; Clinic of Plastic Surgery and Reconstructive Microsurgery, Central Military University Emergency Hospital, Bucharest, Romania.
J Med Life. 2014;7 Spec No. 3(Spec Iss 3):123-6.
Major degloving injuries of the lower limb are daunting lesions because they are relatively rare and always produce larger soft tissue defects than direct visual inspection that could be predicted in the emergency room. Enough body of the medical literature supports the excision of the avulsed tissue and replaces it as a full-thickness skin graft. However, almost paradoxically, there is little support for the use of pristine large full-thickness skin graft in the treatment of these lesions. This article focuses on the use of tangential hydrodissection (VERSAJET Hydrosurgery System, Smith & Nephew) in preparing the avulsed wound and defatting of a large piece of full thickness skin graft taken from the abdomen by using a standard panniculectomy excision pattern and securing survival and integration of the graft with negative pressure wound therapy. The patient, a 60-year-old obese and diabetic woman, suffered a roadside accident producing a degloving injury of her leg and was treated with the presented method; the final result was excellent and the reduction of the abdominal panniculus was a bonus.
下肢严重脱套伤是令人棘手的损伤，因为它们相对罕见，且总会产生比急诊室直接肉眼检查所预计的更大的软组织缺损。大量医学文献支持切除撕脱组织并用全厚皮片进行替代。然而，几乎自相矛盾的是，对于在这些损伤的治疗中使用完整的大张全厚皮片几乎没有支持依据。本文重点介绍使用切线水分离术（VERSAJET水刀手术系统，施乐辉公司）来处理撕脱伤口，并通过采用标准的腹壁成形术切除模式对取自腹部的一大块全厚皮片进行去脂处理，以及利用负压伤口治疗确保皮片存活和融合。该患者是一名60岁的肥胖糖尿病女性，因路边事故导致腿部脱套伤，并接受了本文所述方法的治疗；最终结果极佳，而且腹部赘肉的减少更是意外之喜。
