为患有广泛的软组织损伤的儿童提供医疗护理的重要方面(三项临床观察的描述以及对治疗中错误的分析)

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详细

论证。外伤病是21世纪的一种流行病,这是由于高速运输,自然和人为紧急事件以及局部战争的数量不断增加所致。这些都会导致患者出现严重的合并伤、多发伤,时常也会有联合伤。外伤性皮肤脱离是高能量创伤影响的结果。由于此类患者病情严重,基础肌肉组织的破坏,此类患者的治疗存在一定的困难,这与医疗的特殊性有关。

临床观察。本文介绍了一系列成功外伤性皮肤脱离患者的临床实例,包括多发性损伤的患者,其中及时纠正治疗策略使避免负面后果。

讨论。对于处于稳定状态且没有破坏下层肌肉组织的创伤性全层皮肤脱离的患者,应使用根据克拉西托夫的传统全层游离皮肤移植术进行治疗,而对处于不稳定(失代偿)状态的下肢创伤性全层皮肤脱落的受伤患者的治疗,在下面肌肉组织破坏的情况下,应采用分阶段全层游离皮肤移植术,并可能使用基于壳聚糖的生物涂层。

结论。所介绍的临床实例反映了在组织为受害者提供医疗援助的所有阶段中,采用统一方法处理伤害的重要性。

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作者简介

Sergei Bogdanov

Scientific Research Institution — Regional Clinical Hospital No. 1 named by professor S.V. Ochapovsky; Kuban State Medical University

编辑信件的主要联系方式.
Email: bogdanovsb@mail.ru
ORCID iD: 0000-0001-9573-4776
SPIN 代码: 2465-5462

MD, PhD, D.Sc.

俄罗斯联邦, 167 1st May str., Krasnodar, 350086; Krasnodar

Aleksandr Blazhenko

Scientific Research Institution — Regional Clinical Hospital No. 1 named by professor S.V. Ochapovsky; Kuban State Medical University

Email: vertebr58@mail.ru
ORCID iD: 0000-0002-9957-1422
SPIN 代码: 5819-1988

MD, PhD, D.Sc., Associate Professor

俄罗斯联邦, 167 1st May str., Krasnodar, 350086; Krasnodar

Sergei Kurinniy

Scientific Research Institution — Regional Clinical Hospital No. 1 named by professor S.V. Ochapovsky; Kuban State Medical University

Email: way_doc@mail.ru
ORCID iD: 0000-0002-8780-5308

PhD student

俄罗斯联邦, 167 1st May str., Krasnodar, 350086; Krasnodar

Mikhail Mukhanov

Kuban State Medical University

Email: pputinn@yandex.ru
ORCID iD: 0000-0002-9061-6014
SPIN 代码: 3684-9725

MD, PhD, Associate Professor

俄罗斯联邦, Krasnodar

Andrey Boyko

Kuban State Medical University

Email: andreyboyko2511@yandex.ru
ORCID iD: 0000-0003-0796-4526
SPIN 代码: 6932-9491

MD, clinical resident

俄罗斯联邦, Krasnodar

Anton Karakulev

Scientific Research Institution — Regional Clinical Hospital No. 1 named by professor S.V. Ochapovsky; Kuban State Medical University

Email: karakulev797@gmail.com
ORCID iD: 0000-0002-5477-5755
SPIN 代码: 9687-7717

MD, PhD student

俄罗斯联邦, 167 1st May str., Krasnodar, 350086; Krasnodar

Valeriya Aladina

Scientific Research Institution — Regional Clinical Hospital No. 1 named by professor S.V. Ochapovsky; Kuban State Medical University

Email: lerka309@mail.ru
ORCID iD: 0000-0002-4580-6839
SPIN 代码: 5218-7831

MD

俄罗斯联邦, 167 1st May str., Krasnodar, 350086; Krasnodar

参考

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  2. Loktionov PV, Gudz’ JV. Opyt lechenija ran nizhnih konechnostej s obshirnoj travmaticheskoj otslojkoj kozhi i podkozhnoj kletchatki. Mediko-biologicheskiei social’no-psihologicheskie problem bezopasnosti v chrezvychajnyh situacijah. 2015;1 22–28. (In Russ.). doi: 10.25016/2541-7487-2015-0-1-22-28
  3. Sokolov VA. [Internet]. Obshirnaja travmaticheskaja otslojka kozhi i kletchatki konechnostej i tulovishha. (In Russ.). [Cited 2020 April 8]. Available from: https://medbe.ru/materials/politravma/obshirnaya-travmaticheskaya-otsloyka-kozhi-i-kletchatki-konechnostey-i-tulovishcha
  4. Kudsk KA, Sheldon GF, Walton RL. Degloving injuries of the extremities and torso. J Trauma. 1981;21(10):835–839. doi: 10.1097/00005373-198110000-00002
  5. Mello DF, Assef JC, Solda SC, Helene AJr. Degloving injuries of trunk and limbs: comparison of outcomes of early versus delayed assessment by the plastic surgery team. Rev Col Bras Cir. 2015;42(3):143–148. doi: 10.1590/0100-69912015003003
  6. Mir Y, Mir L, Novell AM. Repair of necrotic cutaneous lesions, secondary to tangential traumatism over detachable zones. Plast Reconstr Surg. 1950;6(4):264–274. doi: 10.1097/00006534-195010000-00002
  7. Bogdanov SB, Afaunova ON. Ispol’zovanie ranevyh pokrytij pri rannem hirurgicheskom lechenii pogranichnyh ozhogov konechnostej v funkcional’no aktivnyh oblastyah. Vrach-aspirant. 2016;79(6):4–9. (In Russ.)
  8. Bogdanov SB, Babichev RG, Marchenko DN, Polyakov AV, Ivashchenko YuV. Plastika polnoslojnymi kozhnymi autotransplantantami ranrazlichnoj etiologii. Innovacionnaya medicina Kubani. 2016;(1):30–37. (In Russ.)
  9. Patent RF naizobretenie No. 2248757/27.03.05. Bogdanov SB, Kurinnyi NA. Sposob plastiki kozhnykh pokrovov konechnostei posle rannei nekrektomii. Available from: https://elibrary.ru/item.asp?id=37962093. (In Russ.)
  10. Patent RF naizobretenie No. 2618166/02.05.20. Bogdanov SB, Babichev RG. Sposob zabora kozhnogo autotransplantata. Available from: https://elibrary.ru/item.asp?id=38263544. (In Russ.)
  11. Patent RF naizobretenie No. 2665676/03.09.18. Bjul. No. 25. Blazhenko AN, Kurinnyj SN, Porhanov VA, Bogdanov SB, Muhanov ML. Sposob svobodnoj otsrochennoj plastiki kozhnym autotransplantatom pritravmaticheskih otslojkah kozhi [сited 2020 April 8]. Available from: https://patentinform.ru/inventions/reg-2665676.html

补充文件

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1. JATS XML
2. 图 1 D患者,12岁,临床诊断为“体表面积为7%左大腿外伤性皮肤脱落“:a-初级清创术后伤口的视图,采用了对位缝合;b-重复清创术后伤口的视图,伤口已缝合,c-湿坏死的迹象;d-干燥坏死的迹象;e-带有敷料的伤口的视图; f-肉芽出现后伤口的视图;g-伤口的整形术;h-植皮手术的最终结果

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3. 图 2 L患者,16岁,诊断:“左脚背软组织的地雷爆炸伤口,外伤性皮肤脱落达0.5%,下肢软组织多处弹片伤”:a-受伤后一小时进行初次缝合;b-重复清创术;切断皮肤和脂肪皮瓣;c-摘出异物

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4. 图 3 P患者,17岁,诊断:“多发性胸部,骨盆,下肢的外伤,左侧气胸,左侧胸膜腔引流后的状况,鸠口,坐骨和左侧髋臼骨的开放性骨折,下肢左髋关节水平的外伤性撕裂,会阴部的伤口,初次清创术后的状况,进行了结肠造口术;按NISS量表伤害严重程度为27分“:a-伤口被缝合,引流;b-17小时后伤口的状态;接缝已拆去;c-缠上真空绷带,负压力为125毫米汞柱;d-第二天重复进行清创术,切除坏死肌肉,去除脂肪组织,e-第五天重复进行清创术,切除坏死肌肉,去除脂肪组织,f-受伤后一个月内最接近的治疗结果,移植物使成活率为100%

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版权所有 © Bogdanov S., Blazhenko A., Kurinniy S., Mukhanov M., Boyko A., Karakulev A., Aladina V., 2021

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