目的 探讨皮肤回植结合负压辅助闭合技术(VAC)治疗儿童皮肤脱套伤的临床效果。方法 2013年8月至2017年8月,共收治42例大面积皮肤脱套伤患儿,其中四肢32例,躯干部8例,头皮2例,清创后削薄皮肤并原位回植,VAC装置覆盖创面,持续负压封闭引流,7 d后拆除VAC材料,观察皮片成活情况。结果 42例中,回植皮片全部存活29例(69.05%);皮片成活面积大于75%的7例(16.67%),多呈局灶性散在皮片坏死,换药后创面全部愈合;成活面积大于50%且小于75%的6例(14.29%),换药后Ⅱ期植皮创面愈合。结论 皮肤回植结合VAC治疗是治疗儿童皮肤脱套伤的有效方法,回植皮肤成活率高,再次手术率低。

Objective To investigate the clinical efficacy of skin replantation combined with vacuum assisted closure (VAC) technology for the treatment of degloving injuries in children. Methods From August 2013 to August 2017, 42 patients (42 wounds) with large area of degloving injury (32 in limbs and legs, 8 in trunk and 2 in head )were included in this study. Skin replantation and VAC technique were applied in all patients after debridement. The skin condition was observed. Results The flaps all survived in 29 cases (69.05%). In 7 cases, the survival area of the flap was more than 75% (14.29%) because of local skin necrosis which healed after a short term dressing. In 6 cases, the survival area of the flap was more than 50% and less than 75% (14.29%), and the residue wound were healed by secondary skin grafting. Conclusion The skin replantation combined with VAC technology is an effective method for the treatment of degloving injuries in children. It can not only improve the skin graft survival significantly, but also reduce the incidence of secondary operation.