Retrospective Study And Analysis On Surgical Treatment Of Skin Avulsion Injuries Of Extremities

Research background:With the improvement of industrialization and the popularization of transportation,the number of traumatic cases per year remains high.As a common trauma,skin avulsion injuries are also more common.Skin avulsion injuries are caused by violence on the skin,causing the skin and soft tissues to lose their original anatomical position.Exfoliation from superficial fascia or deep fascia is often accompanied by damage and exposure of deep tissues such as muscles and blood vessels.Especially patients with large avulsion injuries are often accompanied by a large amount of bleeding,and individual patients are accompanied by hemorrhagic shock.This requires treatment in accordance with the principle of fastest and closest approach,but there is no complete set of clinical guidelines for the specific diagnosis and treatment of avulsion injuries.This study aims to compare the advantages and disadvantages and indications of different surgical methods by summarizing the cause of injury,injury mechanism,avulsion type,and surgical method of avulsion injury,and to make further analysis to better treat various parts,Type of skin avulsion injury.Methods:A systematic review of the patients with extremity skin avulsions admitted to Shandong Provincial Hospital during the six years from 2015 to 2020.The study was divided into the hand group and the non-hand extremity group,and the skin and subcutaneous anatomical characteristics of different parts were compared.Analyze the common causes of skin avulsion in different parts,understand the avulsion mechanism and injury characteristics of different parts of skin avulsion,and further compare the surgical methods of different parts of skin avulsion.Common surgical methods include in-situ suture,replantation of thinned skin grafts+vacuum sealing drainage(VSD),flap repair,primary debridement+VSD+secondary skin grafting,etc.We can analyze the collected cases and compare the indications and advantages and disadvantages of different surgical methods by comparing the first-stage wound healing rate,average number of operations,average hospital stay,postoperative functional recovery and other indicators,so as to choose the most appropriate surgery the way.Results:This study included 107 patients with avulsion of limbs,including 66 males and 41 females.The oldest was 77 years old,and the youngest was 1 year old,with an average of 38.06±17.36 years old;the largest area was 15%(body surface area),and the smallest was less than 1×2cm.;Among them,32 cases were fingers,35 cases were palms and backs of hands,10 cases were forearms and upper arms,and 30 cases were lower extremities(including feet).The most common cause of hand avulsion injuries was crush injuries,and the rest were sharp cut injuries and machine belt twists..The most common cause of skin avulsion injuries of both upper limbs is machine belt twisting,and the rest are car accident injuries;the most common cause of skin avulsion injuries of both lower limbs is car accident injury.In the treatment of hand skin avulsions,in situ suture,flap repair and reverse skin replantation are more significant than traditional primary debridement and secondary repair in terms of shortening hospital stay and reducing the number of operations.Advantages,and the success rate of effective first-stage wound closure is higher,and the success rate of in-situ suture surgery for patients with hand(small area)avulsion injury is high;in the treatment of non-hand limb avulsion injury,in-situ suture Compared with traditional first-stage debridement and second-stage repair,it also has significant advantages in shortening the hospital stay and reducing the number of operations,and the success rate of effective first-stage wound closure is higher.With the skin grafting method,the avulsed skin flap can be used as "waste" reducing secondary donor site damage caused by surgery.Conclusion:The choice of surgical methods and prognosis of skin avulsion injuries are closely related to the following factors,such as the degree of contamination of the wound,thorough early debridement,the integrity of the avulsed skin,and the blood supply of the avulsed skin.The most ideal surgical method for hand avulsion injury is in-situ suture+flap repair.The postoperative finger sensation and motor function are more advantageous than skin graft surgery;both upper limbs(not including hands)and lower limbs(including feet)The most ideal surgical method is reverse skin peeling and replantation+secondary skin grafting+VSD;compared with the traditional "primary debridement and secondary skin grafting" method,different parts of the surgery are adapted to different parts,and the primary wound healing rate is higher.,The patient’s hospital stay is shorter and the number of operations is less,not only can achieve more ideal surgical results,but also greatly reduce the pressure on all aspects of the patient.