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经皮治疗闭合性大面积皮肤剥脱伤
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经皮治疗闭合性大面积皮肤剥脱伤 Percutaneous Management of Morel-Lavallee Lesions Susan Tseng, MD1 and Paul Tornetta, III, MD2 background: Previous recommendations for treatment of Morel-Lavallee soft-tissue degloving lesions have included open débridement with packing or delayed closure. The purpose of this study was to review the use of percutaneous drainage for the initial management of these lesions. Methods: Nineteen patients with a Morel-Lavallee lesion were managed with percutaneous drainage and débridement of the lesion within three days after the injury. Drainage was usually completed through two 2-cm incisions: one over the distal aspect of the lesion and one over the most superior and posterior extent of the lesion. A plastic brush was used to débride the injured fatty tissue, which was washed from the wound with pulsed lavage. A medium Hemovac drain was placed within the lesion and was removed when drainage was <30 mL over twenty-four hours. Results: Fifteen of the nineteen patients had surgery for an associated pelvic or acetabular fracture. Seven of the nine patients in whom a pelvic fracture was treated surgically had percutaneous fixation of the posterior part of the pelvic ring as well as treatment of the Morel-Lavallee lesion during the same operative setting. Fixation of the remaining two pelvic fractures and the six acetabular fractures was deferred until at least twenty-four hours after the drain was removed. Three of sixteen cultures of specimens taken from the wounds were positive. None of the patients with percutaneous fixation of the pelvis had wound complications. One wound required surgical exploration because of persistent drainage, but the culture was negative and the wound healed with no sequelae. No patient required débridement of skin and, at a minimum of six months, no deep infection had occurred. Conclusions: Early percutaneous drainage with débridement, irrigation, and suction drainage for the treatment of Morel-Lavallee lesions appears to be safe and effective. Percutaneous procedures for pelvic fixation were well tolerated by the small number of patients in this series, and open procedures appeared to be safe when performed in a delayed fashion. 经皮治疗闭合性大面积皮肤剥脱伤 背景：对于闭合性大面积皮肤剥脱伤的治疗目前包括清创加压包扎和二期清创，本研究的目的是检验经皮引流治疗疗效 方法：19例病人在伤后三天内采用经皮引流和清创术治疗。通过两个2厘米的创口进行引流，一个在创口的远端，另一个在近端偏后的位置。用塑料刷刷除已挫伤的脂肪组织，脉冲冲洗创面，创口内置入引流管，每小时引流小于30毫升时拔除。 结果：15例患者合并有骨盆及髋臼的骨折，9例合并有骨盆骨折患者中的7例在治疗软组织损伤的同时经皮固定了骨盆环的后部。其余的2例骨盆骨折及6例髋臼骨折在引流拔除后24小时内做固定手术。在送检的16例标本培养中有3例阳性，经皮固定骨盆环的患者均未出现创口并发症，1例因为持续的引流而行手术探察，但培养阴性，创口良好愈合。在术后6个月内，所有患者均未再行清创，均未有深部感染发生。 结论：对大面积闭合性皮肤潜行剥脱伤的患者进行早期的经皮冲洗，清创引流是安全有效的，对合并有骨盆骨折的少数患者采用经皮固定疗效满意，但对延迟的患者还需要开放治疗。 |
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