摘要：
Objective To investigate the clinical therapeutic effects of stretch regeneration according to law of tension stress for skin defects.Methods We reviewed the 16 patients with skin defect who had been treated at Department of Traumatic Orthopaedics and Hand Surgery,The First Affiliated Hospital,Guangxi Medical University by skin traction band made of a sterile blood transfusion apparatus and sterile nylon strips from March 2016 to July 2017.They were 12 males and 4 females,aged from 7 to 68 years (average,33 years).The areas of their skin defects ranged from 6 cm × 3 cm to 20 cm × 5 cm.After thorough debridement,a simple skin traction band made of a sterile blood transfusion apparatus and a number of aseptic nylon strips was placed on both margins of the wound,1 cm apart from the margin.The distances between wound holes ranged from 1.5 to 2.0 cm.The simple tension band was installed along the wound margins.After operation,the skin traction band was gradually tightened,according to the tension,blood supply to the skin margins and feeling of the distal end of the affected limb,to close the wound until interrupted suture of the skin was conducted.Results The wounds were closed by interrupted suture directly after application of the skin traction band in 13 of the 16 patients.The wounds were repaired by secondary vacuum sealing drainage (VSD) and skin graft in 2 cases with foot avulsed injury and infection in whom the traction band was pulled out along the wound skin margins.Skin graft was applied in one case with massive forearm skin defect and infection after the traction band failed.Follow-ups from 3 to 19 months revealed that application of the skin traction band led to linear scar healing,soft scar,little pigmentation,no tickle,no adjacent joint dysfunction due to skin contracture and normal pain sensation in most of the patients.Conclusion Stretch regeneration according to law of tension stress is an effective,simple and economical treatment of skin defects,deserving popularization.%目的 初步探讨应用张力-应力法则牵张再生治疗皮肤缺损的临床疗效.方法 回顾性分析广西医科大学第一附属医院创伤骨科手外科2016年3月至2017年7月应用无菌输血器及尼龙扎带制成皮肤牵张带治疗的16例皮肤缺损患者资料,其中男12例,女4例;年龄7～68岁,平均33岁;皮肤缺损面积约6 cm×3 cm～20 cm ×5 cm.利用一根无菌硅胶输血管及数根无菌尼龙扎带制成简易皮肤牵张带,彻底清创后置于创缘两侧,距创缘1.0cm处,孔间距1.5～2.0 cm,沿创缘依次安装简易张力带.术后每天根据张力、皮缘血供、患肢远端感觉情况,逐渐收紧皮肤牵张带,缩小及闭合创面直至皮缘贴合,再行皮肤间断缝合. 结果 16例患者中有13例应用皮肤牵张带后直接完整间断缝合皮肤创面;2例足部撕脱伤并感染患者因牵张带沿着皮缘脱出,后期行负压封闭引流加植皮修复创面;1例前臂软组织缺损较大并感染患者,因牵张失败改行植皮治疗.经过3 ～19个月随访,发现大多数皮肤缺损患者获得线性瘢痕愈合,瘢痕柔软,局部少许色素沉着,无瘙痒及邻近关节因皮肤挛缩引起的关节活动障碍,痛触觉正常. 结论 应用张力-应力法则牵张再生治疗皮肤缺损是一种有效、简便、经济的治疗方法,值得推广.
