目的 探讨髂腹股沟皮瓣联合阔筋膜张肌肌皮瓣修复Fournier坏疽所致会阴部软组织缺损的临床疗效.方法 自 2015 年 1 月至 2021 年 6 月,北京大望路急诊抢救医院烧伤整形科收治 5 例坏死性筋膜炎所致会阴部皮肤软组织缺损患者,采用早期清创引流及围手术期综合支持治疗,患者经 3～5 次清创、VSD引流及加强换药,采用敏感抗生素后(平均24.5 d)观察创面无明显失去活性组织,表面有质硬、新鲜出血的肉芽组织后进行皮瓣移植手术,患者均有不同程度的双侧睾丸裸露,会阴部创面面积为 12 cm×14 cm～20 cm×11 cm(阴囊皮肤缺损均>2/3).均采用单侧髂腹股沟皮瓣联合阔筋膜张肌肌皮瓣修复缺损区,供瓣区直接缝合关闭.结果 5 例患者全部治愈,无严重并发症发生,术后排尿功能正常.随访 6～12 个月,创面无破溃,无感染复发等发生.2例患者皮瓣略显臃肿,创面愈合 6 个月后行皮瓣修薄,随访 12 个月观察皮瓣无臃肿、质地柔软、弹性良好,排尿体位及功能正常.所有患者双下肢活动与治疗前无差别.结论 髂腹股沟皮瓣联合阔筋膜张肌肌皮瓣修复坏死性筋膜炎所致会阴部软组织缺损的效果较佳,术后外形及功能良好,手术方法简单,易于推广.

目的 探讨采用髂腹股沟皮瓣修复小儿阴阜部瘢痕的效果.方法 自2016年1月至2020年10月,北京大望路急诊抢救医院烧伤整形科采用髂腹股沟皮瓣修复8例热烧伤后小儿阴阜部瘢痕挛缩畸形患儿.瘢痕增生时间6个月至3年;阴阜部瘢痕切除松解后继发裸露创面为8 cm×12 cm～10 cm×18 cm.8例患儿均采用单侧髂腹股沟皮瓣转移修复,供瓣区直接拉拢缝合或通过局部辅助接力皮瓣转移修复.术后用"人"字形支具固定双下肢于屈曲外展位,严格制动.结果 8例患儿皮瓣全部成活,瘢痕完全去除,畸形得到改善.随访6～12个月,生殖器回归正常生理解剖位置,皮瓣外形良好,无臃肿,质地柔软,颜色与受区接近,无挛缩,皮肤无炎症,未出现破溃,无继发瘢痕挛缩畸形,排便正常,患儿家属对手术效果满意.结论 通过一次手术采用髂腹股沟皮瓣修复小儿阴阜部瘢痕挛缩畸形,操作简单,疗效较好,有一定临床价值.

From May 2013 to March 2020, 25 patients with acute necrotizing fasciitis were admitted to Beijing Chaoyang Emergency Rescue Center, including 18 males and 7 females, aged 7 to 78 years. The lesions were mainly located in the lower extremities, with the original lesion areas ranging from 20 cm×15 cm to 83 cm×42 cm. After admission, comprehensive systemic treatment was performed, the lesion area was cut open and drained as soon as possible, and the necrotic tissue was removed. Vacuum sealing drainage was performed when the necrotic tissue in the wound was reduced. The wounds were directly sutured or repaired with thin split-thickness skin grafts taken from head and/or thigh or local skin flaps after the wounds were improved. The skin grafts and flaps survived well after surgery, and the wound was completely closed. None of the 25 patients had amputation. A total of 21 patients were followed up for more than half a year, showing no recurrence of acute necrotizing fasciitis and no difference in the function of their injured limb after the wound healing than before the onset.

感染性因素易造成阴茎和阴囊皮肤较大范围缺损,局部炎性反应重,深部组织裸露明显,多不能靠残留的阴茎或阴囊的皮肤组织来修复,需要皮瓣移植来重建阴茎和阴囊的包被组织.我们采用皮片移植加邻位皮瓣移植修复5例严重阴茎和阴囊皮肤大范围缺损患者,取得了较好效果,报告如下.

目的:研究危重烧伤患者血栓弹力图、凝血指标及血小板变化的临床意义.方法:回顾性分析本院烧伤科在2015年10月-2016年10月收治的50例危重烧伤患者临床资料作为研究对象,将其作为观察组,在患者烧伤后3 d内的渗出期对患者的血栓弹力图(TEG)、血小板(PLT)及凝血指标进行检测,在患者渗出期过后并且全身情况稳定之后进行扩张器与皮瓣联合治疗创面,在手术前检测患者的血栓弹力图、凝血指标及血小板水平.另外选择2015年10月-2016年10月在本院进行健康体检的50例健康人员作为对照组.观察比较两组的血栓弹力图、凝血指标及血小板水平.结果:与对照组比较,观察组患者渗出期的R值、K值及PLT均明显减小,CI值和α角均明显增加,差异均有统计学意义(P<0.05);两组的凝血指标比较,差异均无统计学意义(P>0.05).观察组患者手术前的MA值、R值、PLT、Fb均高于渗出期,TT短于渗出期,差异均有统计学意义(P<0.05).观察组患者渗出期的α角和PLT、Fb均呈正相关(P<0.05);R值和APTT呈正相关(P<0.05);MA值和Fb、PLT均存在正相关(P<0.05);MA值和TT存在负相关(P<0.05);K值和Fb、PLT均呈正相关(P<0.05);CI值和APTT、Fb均呈正相关(P<0.05).结论:危重烧伤患者的凝血功能会出现一定的变化及异常,血栓弹力图和血小板变化及凝血指标具有一定的相关性,三者具有一定的互补作用,对危重烧伤患者凝血功能的全面评估及输血指导、出血风险的判断具有重要的现实意义.

Objective: To evaluate the effect of subcutaneous injection of low molecular weight heparin calcium on deep vein thrombosis (DVT) formation, wound healing and infection rate after skin-grafting in patients with burn. Methods: Two hundred patients with burn requiring skin grafting admitted to the Beijing Chaoyang Emergency Center from Feb. 2015 to Feb. 2017 were involved in present study and randomly divided into observation group and control group (100 each). Patients in observation group received basic treatment and subcutaneous injection of low molecular heparin calcium (2800 IU/d from 1-day preoperation to 3-day postoperation, and then 4800 IU/d from 4-day to 7-day postoperation), while patients in control group received basic treatment only (such as infrared physiotherapy irradiation, hot compress with magnesium sulfate and muscle massage). The changes of the contents of plasma D-dimer, platelet count, as well as wound healing rate, DVT formation and infective rate were observed and compared between the two groups on the day 3, 7 and 11 postoperation. Results: The plasma D-dimer and platelet counts were markedly lower on the 3rd, 7th and 11th day after skin grafting in observation group than in control group (P<0.05). The incidence of DVT was obviously higher in control group (6.0％) than in observation group (0, P<0.05). The infection rate was significantly lower in observation group (2.0％) than in control group (10.0％, P<0.05), but no statistical difference existed between the two groups in wound healing time (P>0.05). Conclusions: Subcutaneous injection of low molecular weight heparin calcium can effectually prevent DVT from formation in burned patients and reduce infection rate after skin-grafting.

眼睑皮肤的深度烧伤常会引起眼睑的瘢痕挛缩，导致明显的睑外翻，影响外观和引起不同程度的视力损害。我们对8例面部深度烧伤患者采取烧伤早期眼睑切痂全厚植皮，取得良好的效果。