Xu Qianqian, Xu Jihai, Shen Yijun, Zhang Chenxi, Shen Hangchong, Huang Tianxiang, Lu Chenlin, Wang Xin
Health Science Center, Ningbo University, Ningbo Zhejiang, 315211, P. R. China.
Department of Hand Surgery, Ningbo No.6 Hospital, Ningbo Zhejiang, 315042, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2025 Jan 15;39(1):95-99. doi: 10.7507/1002-1892.202411057.
To investigate the effectiveness of delayed replantation of degloving skin preserved at 4℃ in treatment of limb degloving injuries.
Between October 2020 and October 2023, 12 patients with limb degloving injuries were admitted. All patients had severe associated injuries or poor wound conditions that prevented primary replantation. There were 7 males and 5 females; age ranged from 29 to 46 years, with an average of 39.2 years. The causes of injury included machine entanglement in 6 cases, traffic accidents in 5 cases, and sharp instrument cuts in 1 case. Time from injury to hospital admission was 0.5-3.0 hours, with an average of 1.3 hours. Injury sites included upper limbs in 7 cases and lower limbs in 5 cases. The range of degloving skin was from 5 cm×4 cm to 15 cm×8 cm, and all degloving skins were intact. The degloving skin was preserved at 4℃. After the patient's vital signs became stable and the wound conditions improved, it was trimmed into medium-thickness skin grafts for replantation. The degloving skin was preserved for 3 to 7 days. At 4 weeks after replantation, the viability of the degloving skin grafts was assessed, including color, elasticity, and sensation of pain. The Vancouver Scar Scale (VSS) was used to assess the scars of the skin grafts during follow-up.
At 4 weeks after replantation, 8 cases of skin grafts completely survived and the color was similar with normal skin, with a survival rate of 66.67%. The elasticity of skin grafts (R0 value) ranged from 0.09 to 0.85, with an average of 0.55; moderate pain was reported in 4 cases, mild pain in 3 cases, and no pain in 5 cases. All patients were followed up 12 months. Over time, the VSS scores of all 12 patients gradually decreased, with a range of 4-11 at 12 months (mean, 6.8).
For limb degloving injuries that cannot be replanted immediately and do not have the conditions for deep low-temperature freezing preservation, the method of preserving the degloving skin at 4℃ for delayed replantation can be chosen.
探讨4℃保存的脱套皮肤延迟再植治疗肢体脱套伤的疗效。
选取2020年10月至2023年10月收治的12例肢体脱套伤患者。所有患者均伴有严重合并伤或伤口条件差，无法进行一期再植。其中男性7例，女性5例；年龄29～46岁，平均39.2岁。致伤原因包括机器绞伤6例，交通事故5例，锐器切割伤1例。伤后至入院时间为0.5～3.0小时，平均1.3小时。损伤部位上肢7例，下肢5例。脱套皮肤范围为5 cm×4 cm至15 cm×8 cm，所有脱套皮肤均完整。将脱套皮肤于4℃保存。待患者生命体征平稳、伤口条件改善后，修剪成中厚皮片进行再植。脱套皮肤保存3～7天。再植后4周，评估脱套皮片的存活情况，包括颜色、弹性及痛觉。随访期间采用温哥华瘢痕量表（VSS）评估皮片瘢痕情况。
再植后4周，8例皮片完全存活且颜色与正常皮肤相近，成活率为66.67%。皮片弹性（R0值）为0.09～0.85，平均0.55；4例有中度疼痛，3例有轻度疼痛，5例无疼痛。所有患者均随访12个月。随时间推移，12例患者的VSS评分均逐渐降低，12个月时为4～11分（平均6.8分）。
对于不能立即再植且不具备深低温冷冻保存条件的肢体脱套伤，可选择4℃保存脱套皮肤进行延迟再植的方法。
