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1、功能部位皮肤软组织缺损创面治疗新选择［摘要］目的：总结封闭式负压引流(vacuum-assistedclosure,VAC)技术联合人工真皮(PELNAC)治疗功能部位皮肤软组织缺损创面的良好效果，推广该治疗方法的临床应用。方法：2008年3月〜2011年12月，笔者应用VAC联合PELNAC治疗11例患者13处创面，其中车祸伤9例、自行车辐条搅伤1例、过山车滚轮碾压伤1例，所有创面均位于下肢，均为关节功能部位创面，9例有深部组织外露，伴有不同程度的关节功能障碍。围手术期行全身支持治疗，尽快扩创，行VAC治疗，创面肉芽组
2、织生长新鲜后行PELNAC移植,PELNAC血管化后，行自体刃厚皮片移植。结果：所有创面经VAC治疗后，肉芽组织生长迅速，部分或完全覆盖深部外露组织，行PELNAC加自体刃厚皮片移植，12处创面一次性愈合，总治愈率为92.3%o随访半年〜3年，创面愈合后无明显瘢痕增生，外观较好，功能佳。结论：VAC联合人工真皮治疗功能部深创面，明显缩短疗程，提高愈合质量，值得进一步推广使用。［关键词］封闭式负压引流；创面；人工真皮；刃厚皮片［中图分类号1R622［文献标识码］A［文章编号］1008-6455(2013)01-0108-0
3、3AnewchoicetotreatskinandsofttissuesdefectedwoundsoffunctionalpartLIUFei,ZHANGCheng-wei,GUOZheng-dong,LINHai-bo,HONGHao,YANGWei-guo,LIANGZhi(DepartmentofPlasticandCosmeticSurgery,NanshanAffiliatedHospitalofGuangdongMedicalCollege,Shenzhen518052,Guangdong,China)Ab
4、stract：ObjectiveTosummarizegoodresuItsofvacuum-assistedclosure(VAC)combinedwithartificialdermis(PELNAC)totreatskinandsofttissuesdefectedwoundsoffunctionalpart,andextendsclinicalapplicationofthemethod・Methods11patientswith13wounds,hospitalizedfromMarch2008toDecemb
5、er2011,weretreatedwithVACandPELNAC・Thetrafficaccidentwounds(9cases),injuryduetorollbythewirespokeofbicycle(1cases),injuryduetorun-overbytherollercoaster(1cases),allwoundsaresituatedthejointoflowerlimbs,deepertissueexposed(9cases),accompanyingdifferentdegreejointd
6、ysfunction.Allthepatientsweregivensystemicsupportingtreatmentinperioperativeperiodandearlydebridement,thenweretreatedwithVAC・Afterthefreshgranulationtissueformed,didPELNACgraft,whenPELNACvascularized,didepidermalskingraftimmediately・ResuItsAftertreatedwithVAC,Gra
7、nulationtissuegrowrapidly,coveredpartialorallexposeddeepertissue.AfterPELNACandepidermalskingraft,12woundshealed・Thetotalhealingratewas92.3%.Afterafollow-up6to36months,thehealingwoundswithouthypertrophicscar,appearancespeciously,andbetterfunction.ConclusionVACass
8、ociatewithtreatedthedeeperfunctionaljointwounds,shortenedthecourseoftreatmentobviouslyandimprovedthequalityofhealing.Themethodisdeservedfurtherpromotionandappl
