- 期刊
Using Modified Shoelace Technique in Closing Wounds Other than Fasciotomies
綁鞋帶式皮膚牽引法應用於其他非筋膜切開之傷口
摘要
背景： 早期設計使用鞋帶式皮膚牽引手術法，主要目的是為了讓筋膜切開術後的傷口達成初級癒合的一種術式。此法應用皮膚延展性來達成傷口漸次癒合；其有效治療筋膜切開術後傷口已有許多文獻報告。 目的與目標： 此方法應用於其他非筋膜切開術後的缺損性傷口，成效並無定論。吾人將此術式應用於不適合或無意願接受進一步複雜手術的病人上，以期達成延遲性初級癒合；或是減少傷口尺寸，以期達成較快的次級傷口癒合。本篇論文將報告：以鞋帶式皮膚牽引手術法應用於非筋膜切開術後的缺損性傷口的經驗及術式上的改良。 材料及方法： 自西元2004年2月至2005年11月，共有19位病人接受26個鞋帶式皮膚牽引法。初期有13位病人16個傷口接受傳統式皮膚牽引法：這是利用兩排自動縫合釘(Auto-suture staple)平行固定在傷口旁的皮膚來當成「鞋帶孔」，再以No.1PDS為「鞋帶」穿梭於孔間，於手術後以漸進方式將傷口邊緣拉近；但牽引當中，我們發現傷口的邊緣有明顯的內翻現象：這讓原本可以靠在一起的傷口不容易靠近，或是靠在一起的傷口不易癒合。為避免牽引時造成傷口邊緣內翻，吾人改良此術式並施用於6位病人的10個傷口上。改良方是中，吾人利用2-0PDS於傷口邊緣以8字皮下縫法縫成「鞋帶孔」，仍以No.1PDS為「鞋帶」穿梭，術後仍採漸進方式拉攏傷口。 結果： 改良之鞋帶式皮膚牽引法可避免傷口邊緣內翻，此術式作用於傷口邊緣，使之均勻受力，可有效縮小傷口尺寸。受試之傷口因此可達成延遲性初級癒合、或是較快之次級傷口癒合、或是利用較小尺寸皮膚移植被縮小的傷口達成傷口癒合。此術式應用位於骨頭表面或是關節附近之傷口的效果較差。 結論： 改良之鞋帶式皮膚牽引法可被成功的運用於非筋膜切開術後的缺損性傷口，這種術式可有效克服傷口邊緣內翻、有效縮小傷口尺寸，並可減少自體組織移植所造成的併發症。此術式低價並簡單，且利用之材料容易取得。至於多大的傷口可利用這種方式來達到延遲性初級癒合，則有待進一步釐清。
關鍵字
無資料並列摘要
Background: Shoelace dermatotraction was designed for delayed primary closure of fasciotomies. This technique employed the concept of creeping migration of the skin to achieve wound closure progressively and it's efficacy in treating fasciotomies has been discussed by several studies. Aim and Objectives: The applicability of shoelace dermatotraction in different defects and different locations has not been clarified in the past. For patients not suitable for advanced surgeries or unwilling for major surgeries, the shoelace technique was quite useful to reduce the wound dimension. Delayed primary healing or faster secondary healing could be possible. We extrapolated this technique to wounds other than fasciotomies and presented our experience of classical and modified technique in this study. Materials and Methods: From February 2004 to December 2005, twenty six shoelace dermatotractions were performed on varied locations of nineteen patients. The classical shoelace technique was applied with No. 1 PDS interweaving between the skin staples anchored on the wound edge. Wound approximation was achieved by tightening the sutures. This technique was used in 16 wounds of 13 patients. The modified technique was designed to prevent wound edges inversion occurred during traction and was applied to 10 wounds of 6 patients. Instead of staples, figure-of-eight sutures with 2-0 PDS placed on the edges of the wound was used as the anchor for traction. Two No.1 PDS sutures interweaving these 2-0 sutures were used as shoestrings. Results: The wounds closed with modified technique tend to be an edge-to-edge approximation rather than an inversion. Evenly distributed force advanced the margins and shrank the size of defects effectively. Wounds healed either by delayed primary healing, faster secondary healing, or smaller skin grafts. Defects in front of the bones and joints were difficult to be closed by delayed primary intension with shoelace technique. Conclusion: Modified technique conquers skin inversion and efficiently shrinks the defects, reducing donor site morbidity. This technique is cheap, simple, and employs materials with easy availability.