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目的探讨儿童后足摩托车轮辐伤的热损伤特点,总结序贯封闭式负压引流技术(vacuum sealing drainage,VSD)与带蒂皮瓣修复此类损伤的疗效。方法 2010年1月-2014年1月,收治15例单侧后足摩托车轮辐伤患儿。男11例,女4例;年龄3~8岁,平均5.7岁。受伤至入院时间为3~7 d,平均4.9 d。创面部位:单纯足后跟8例,足后跟与外踝2例,内踝与足跟内侧4例,内外踝与足后跟1例。均存在不同程度皮肤、肌腱及骨骼缺损,其中皮肤软组织缺损范围为3 cm×3 cm~13 cm×6 cm。入院后行创面清创,经2~3次VSD治疗后创面清洁、肉芽生长良好后,行皮瓣修复术,其中8例吻合皮神经。皮瓣切取范围为4 cm×4 cm~14 cm×7 cm。结果术后13例皮瓣完全成活,2例皮瓣边缘部分坏死;创面Ⅰ期愈合。供区植皮均成活。术后15例患儿均获随访,随访时间9~21个月,平均13个月。9例皮瓣轻度臃肿,6例中度臃肿。13例患儿足部负重、行走基本恢复正常,2例轻度跛行。8例吻合皮神经皮瓣术后6个月浅感觉均恢复至S3,无皮瓣磨损;7例未吻合皮神经皮瓣术后6个月浅感觉恢复至S2,2例出现皮瓣边缘磨损。术后8个月,根据美国矫形足踝协会(AOFAS)踝-后足评分评价踝关节功能,获优13例,良2例,优良率100%。结论儿童后足摩托车轮辐伤属高能量损伤,合并热损伤,序贯VSD与带蒂皮瓣修复可获较好疗效。
Objective To investigate the characteristics of thermal injury of motorcycle hindlimb injuries in children’s hind legs and summarize the curative effect of sequential closed vacuum drainage drainage (VSD) and pedicle flap on the repair of such injuries. Methods From January 2010 to January 2014, 15 children with unilateral scoliosis motorcycle wounds were treated. 11 males and 4 females; aged 3 to 8 years old, with an average of 5.7 years old. Injury to admission time for 3 ~ 7 d, an average of 4.9 d. Wound sites: simple heel in 8 cases, heel and lateral malleolus in 2 cases, medial malleolus and medial in 4 cases, medial and lateral ankles and heel in 1 case. There are varying degrees of skin, tendon and bone defects, including skin and soft tissue defects in the range of 3 cm × 3 cm ~ 13 cm × 6 cm. After admission, the wounds were debridement wounds. After 2 or 3 VSDs, the wounds were cleaned and the granulation was well-grounded. Skin flap repair was performed, of which 8 patients had anastomosis of the nerve. Skin flap cut range of 4 cm × 4 cm ~ 14 cm × 7 cm. Results Thirteen flaps survived completely and two of the flaps were partially necrotic. The wound healed in the first stage. Grafts for the area are alive. All 15 cases were followed up for 9-21 months with an average of 13 months. Nine flaps were slightly bloated and six were moderately bloated. Thirteen children with foot weight-bearing, walking basically returned to normal, 2 cases of mild limp. 8 cases of anastomotic skin nerve flap recovered to S3 at 6 months postoperatively, no skin flap was worn, and 7 cases of non-anastomosed skin flap had superficial feeling recovered to S2 at 6 months after operation . At 8 months after operation, the ankle-hindfoot score of the American Orthopedic Foot-and-Shoe Association (AOFAS) was used to evaluate the function of the ankle. The results were excellent in 13 cases and good in 2 cases, with an excellent and good rate of 100%. Conclusion Hematoxylin-induced scoliosis of children’s hind-foot motorcycle is a kind of high-energy injury, combined with thermal injury. Sequential VSD and pedicle flap repair can be effective.