Cheng Li-Fu, Lee Jiunn-Tat, Hsu Honda, Wu Meng-Si
From the *Division of Plastic Surgery, Department of Surgery, Buddhist Tzu-Chi General Hospital; †Department of Surgery, Tzu-Chi University, Hualien; and ‡Department of Surgery, Division of Plastic Surgery, Buddhist Tzu-Chi Dalin General Hospital, Chiayi, Taiwan.
Ann Plast Surg. 2017 Mar;78(3 Suppl 2):S52-S57. doi: 10.1097/SAP.0000000000001006.
Numerous conventional wound reconstruction methods, such as wound undermining with direct suture, skin graft, and flap surgery, can be used to treat large wounds. The adequate undermining of the skin flaps of a wound is a commonly used technique for achieving the closure of large tension wounds; however, the use of tension to approximate and suture the skin flaps can cause ischemic marginal necrosis. The purpose of this study is to use elastic rubber bands to relieve the tension of direct wound closure for simultaneously minimizing the risks of wound dehiscence and wound edge ischemia that lead to necrosis.
This retrospective study was conducted to evaluate our clinical experiences with 22 large wounds, which involved performing primary closures under a considerable amount of tension by using elastic rubber bands in a skin-stretching technique after a wide undermining procedure. Assessment of the results entailed complete wound healing and related complications.
All 22 wounds in our study showed fair to good results except for one. The mean success rate was approximately 95.45%.
The simple skin-stretching design enabled tension-free skin closure, which pulled the bilateral undermining skin flaps as bilateral fasciocutaneous advancement flaps. The skin-stretching technique was generally successful.
许多传统的伤口重建方法，如通过直接缝合进行伤口潜行分离、皮肤移植和皮瓣手术，可用于治疗大面积伤口。对伤口皮瓣进行充分的潜行分离是实现大面积张力性伤口闭合的常用技术；然而，利用张力对皮瓣进行拉拢缝合会导致边缘缺血性坏死。本研究的目的是使用弹性橡皮筋减轻伤口直接缝合的张力，同时将导致坏死的伤口裂开和伤口边缘缺血风险降至最低。
本回顾性研究旨在评估我们对22例大面积伤口的临床经验，这些伤口包括在广泛潜行分离术后，采用皮肤拉伸技术使用弹性橡皮筋在相当大的张力下进行一期缝合。对结果的评估包括伤口完全愈合及相关并发症。
我们研究中的22例伤口，除1例之外均显示出较好至良好的结果。平均成功率约为95.45%。
简单的皮肤拉伸设计实现了无张力皮肤闭合，将双侧潜行分离的皮瓣牵拉成双侧筋膜皮瓣推进。皮肤拉伸技术总体上是成功的。
