四肢脱套伤的处理

戴亚辉; 梅炯

doi:10.3969/j.issn.2095-252X.2015.02.22

摘要：Degloving injuries of limbs occur relatively rarely but pose extreme challenges to surgeons, which are usually caused by trafifc accidents or industrial trauma. The key point that differentiates this kind of injury from others is that certain arteries will get damaged due to the separation of the skin and subcutaneous soft tissues from muscles, tendons and fascias, leading to the block of blood lfow. Loss of blood supply means the degloving skin and other soft tissues can hardly live. Mismanagement of such kind of injuries may result in delayed full-thickness necrosis of the avulsed skin lfap, higher complication rate, increased hospitalization and rehabilitation cost, even greater risk of amputation and death. By reviewing past scholars’ management of different types of degloving injuries, it is found that although there are many options available for the management, it is still disputed on how to choose effective treatment strategies and techniques. Some traditional methods are efficient and can be easily put into use in clinic. With the development of science and technology in recent years, new technologies and materials like microsurgical techniques and vaccum sealing drainage ( VSD )/vaccum assisted closure ( VAC ) can provide new options for these injuries, which could greatly reduce the heavy nursing care burden after surgery and decrease the postoperative infection rate. This article is introducing the classification of degloving injuries of limbs, storage methods of degloved skin and discussing the treatment strategies, surgical techniques and prognosis of this kind of injury, aiming to provide some recommendations to surgeons who will face these injuries.