目的:观察应用玉夫膏在足部外伤难愈合创面修复中的临床效果。方法:足部难愈合创面15例,其中足背皮肤缺损肌腱外露6例,足跟部3例,跟腱外露3例,第一跖趾关节外露1例,趾蹼间创面1例,前足外侧创面伴第五跖趾关节外露1例。对15例足部难愈合创面均应用玉夫膏进行局部换药,每日更换1次,直至愈合。结果:15例足部难愈合创面经玉夫膏换药全部愈合,愈合时间最短11天,最长127天。经随访6个月~24个月,平均11个月,所有创面愈合良好,外观平整,不臃肿,局部无明显疼痛和增生性瘢痕,愈合皮肤柔软,有弹性,色素沉着不明显。结论:应用玉夫膏局部换药是修复足部外伤难愈合创面的一种简单、有效的方法。 Objective: To observe the clinical effect of Yufu cream on repair of refractory wounds in foot. Methods: 15 cases with refractory wounds in foot after trauma, including 6 cases of dorsal skin defect tendon exposure, 3 cases of heel tendon exposure, 1 case of first metaltarsal joint exposure, 1 case of interweb wound, 1 case of lateral anterior foot wound with fifth metatarsal joint exposure .all wounds were treated with Yufu cream for local dressing change 1 times every day until they healed. Results: All 15 cases of wounds were healed. The shortest healing time was 11 days and the longest time was 127 days. After follow-up for 6 months to 24 months (mean 11 months), all the wounds healed well, the appearance was smooth, not bloated, there was no obvious pain and hypertrophic scar, the regenerated skin was soft, elastic and the pigmentation was not evident. Conclusion: Local dressing change with Yufu cream is a simple and effective method for repairing refractory wound of foot trauma.
目的:观察应用玉夫膏在足部外伤难愈合创面修复中的临床效果。方法:足部难愈合创面15例,其中足背皮肤缺损肌腱外露6例,足跟部3例,跟腱外露3例,第一跖趾关节外露1例,趾蹼间创面1例,前足外侧创面伴第五跖趾关节外露1例。对15例足部难愈合创面均应用玉夫膏进行局部换药,每日更换1次,直至愈合。结果:15例足部难愈合创面经玉夫膏换药全部愈合,愈合时间最短11天,最长127天。经随访6个月~24个月,平均11个月,所有创面愈合良好,外观平整,不臃肿,局部无明显疼痛和增生性瘢痕,愈合皮肤柔软,有弹性,色素沉着不明显。结论:应用玉夫膏局部换药是修复足部外伤难愈合创面的一种简单、有效的方法。
足,玉服膏,创面,修复,创伤
Yagao Feng1*, Lianwang Hui1, Xiaodong Yang1, Hongshu Liu2
1Department of Wound Treatment, Barke Hospital, Tangshan Hebei
2Hongshu Clinic, Tangshan Hebei
Received: Jun. 10th, 2022; accepted: Jul. 20th, 2022; published: Jul. 28th, 2022
Objective: To observe the clinical effect of Yufu cream on repair of refractory wounds in foot. Methods: 15 cases with refractory wounds in foot after trauma, including 6 cases of dorsal skin defect tendon exposure, 3 cases of heel tendon exposure, 1 case of first metaltarsal joint exposure, 1 case of interweb wound, 1 case of lateral anterior foot wound with fifth metatarsal joint exposure .all wounds were treated with Yufu cream for local dressing change 1 times every day until they healed. Results: All 15 cases of wounds were healed. The shortest healing time was 11 days and the longest time was 127 days. After follow-up for 6 months to 24 months (mean 11 months), all the wounds healed well, the appearance was smooth, not bloated, there was no obvious pain and hypertrophic scar, the regenerated skin was soft, elastic and the pigmentation was not evident. Conclusion: Local dressing change with Yufu cream is a simple and effective method for repairing refractory wound of foot trauma.
Keywords:Foot, Yufu Cream, Wound, Repair, Trauma
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足部难愈合创面是指常规换药无法愈合,且2~4周以上不愈合的创面,常合并肌腱、血管、神经、骨骼外露,其修复一直是临床棘手的问题。传统的修复方法多采用植皮、局部皮瓣转移或吻合血管的皮瓣移植修复,同时还联合应用负压引流技术或人工真皮以及新型医用敷料等综合措施,技术要求高,有一定的失败率,并且皮瓣切取后供区遗留一定损伤,供区遗留的创面仍需进一步修复 [
本组男9例,女6例。年龄18岁~71岁。挤压伤8例,撕脱伤4例,摔伤2例,砸伤1例;足背皮肤缺损肌腱外露6例,足跟部3例,跟腱外露3例,第一跖趾关节外露1例,趾蹼间创面1例,前足外侧创面伴第五跖趾关节外露1例,所有病例均合并肌腱或骨外露,缺损面积为12 cm × 10 cm~4 cm × 2 cm。本组均为采用传统常规换药2~4周以上,仍无法愈合或无愈合迹象的病例,而且每个病例因各种原因无法用常规手术进行修复。
1) 创面处理:清洁创面一般无需手术,创面用生理盐水纱布或棉签擦洗,亦可用甲硝唑注射液擦洗创面,清除分泌物及液化脱落的坏死组织后使用玉夫膏。若创面不新鲜或污染较重的创面,可行简单清创术后使用玉夫膏。
2) 玉夫膏使用方法:直接将足量玉夫膏涂抹在创面上,用4~6层纱布覆盖包扎即可。玉夫膏涂抹的范围要超出创面1~2 cm为宜,厚度达到0.2~0.3 cm,要确保创面24小时保持湿润,用量以下次换药取下纱布时不粘附伤口为准。如在使用玉夫膏之前创面局部有红、肿、热、痛等感染指征和全身发热症状,建议使用抗生素治疗。
经玉夫膏局部换药,15例足部创面全部愈合。愈合时间最短11天,最长127天。创面愈合后局部无明显肿胀,外形平整不臃肿。术后随访6~24个月,创面愈合后新生的皮肤自然,柔软,有弹性,色素沉着不明显,再生皮肤均恢复了保护性感觉,局部无明显压痛,无破溃病例。
典型病例1:患者女性,59岁。左足车祸砸伤入院,检查左足背皮肤缺损,约12 cm × 10 cm,骨质、肌腱外露。入院后急诊行清创术,应用VSD负压吸引术两次,12天后拟行皮瓣移植手术。家属及患者拒绝手术,采用巴克玉夫膏局部换药,每天1~2次,期间剪除部分坏死肌腱,经127天创面愈合。随访9个月,患足外形良好,再生皮肤外形平整不臃肿,色素沉着不明显,皮肤柔软有弹性,瘢痕增生不明显,行走功能良好。见病例1附图1(a)~(i)。
图1. 患者女性,59岁。左足背皮肤缺损骨质、肌腱外露创面愈合过程;(a) 伤后12天足背创面情况;(b) 换药第4天;(c) 应用玉夫膏换药第30天;(d) 应用玉夫膏换药第45天;(e) 应用玉夫膏换药第60天;(f) 应用玉夫膏换药第80天;(g) 应用玉夫膏换药第90天;(h) 创面愈合后9个月随访情况;(i) 创面愈合后9个月随访情况
典型病例2:患者男性,71岁。右跟骨骨折术后钢板外露一月,采用巴克玉夫膏局部换药,每天1次,经35天换药后创面愈合,愈合创面无感染无破溃。随访12个月,愈合创面外观平整不臃肿,再生皮肤色泽质地与周围皮肤相近,无明显色素沉着,无明显瘢痕增生,皮肤柔软有弹性。见病例2附图2(a)~(i)。
图2. 患者70岁,右跟骨骨折术后钢板外露创面愈合过程;(a) 跟骨骨折术后钢板外露情况;(b) 应用玉夫膏换药第3天;(c) 应用玉夫膏换药第8天;(d) 应用玉夫膏换药第14天;(e) 应用玉夫膏换药第20天;(f) 应用玉夫膏换药第30天;(g) 应用玉夫膏换药第35天;(h) 创面愈合后一年后随访情况;(i) 创面愈合后一年后随访情况
典型病例3:患者女性,23岁。右足跟腱断裂术后跟腱外露20天创面不愈合,采用巴克玉夫膏局部换药,每天1次,第47天不慎摔倒跟腱部分断裂,行清创跟腱修复局部桥式皮瓣转移覆盖跟腱,皮下置管于跟腱表面,每天注射液化玉夫膏,伤口继续使用玉夫膏换药,第55天拔出皮下置管,继续用玉夫膏局部换药,经79天换药后创面完全愈合。随访6个月创面愈合良好,再生皮肤平整不臃肿,色泽质地与周围皮肤相近,色素沉着不明显,皮肤柔软有弹性,踝关节屈伸活动及提踵功能良好。见病例3附图3(a)~(i)。
图3. 患者女性,23岁,右足跟腱断裂修复术后跟腱外露创面愈合过程;(a) 创面情况;(b) 应用玉夫膏换药第21天;(c) 应用玉夫膏换药第46天;(d) 第47天再次摔伤后跟腱及创面情况;(e) 再次摔伤后继续用玉夫膏换药;(f) 应用玉夫膏换药第64天;(g) 应用玉夫膏换药第79天;(h) 创面愈合后6个月随访情况; (i) 创面愈合后6个月随访情况
足部难愈合创面常伴有皮肤软组织缺损骨骼、肌腱外露,此类创面采用常规换药或直接植皮无法愈合 [
玉夫膏又称巴氏愈肤膏,冀卫消证字(2017)第0056号(唐山),主要成分为藏红花、黄连、黄柏、黄芩、珍珠、黄凡士林、羊毛脂、甘油、茶油等,起初主要应用于烧烫伤创面,但在足部难愈合创面的修复中应用未见报道 [
1、应用玉夫膏换药,创面及周围皮肤不需用碘酒、碘伏或酒精消毒,以防止刺激创面形成纤维化,影响创面肉芽生长,只用生理盐水或甲硝唑注射液冲洗伤口,亦可用生理盐水或甲硝唑注射液纱布或棉签擦拭清洁创面;2、使用玉夫膏要足量,足量换药的表现为:① 下次换药接开纱布时纱布与伤口不黏连,② 创面无新鲜血液流出,③ 伤口周围发白;3、玉夫膏为油性膏状,足量涂抹在创面后要用4~6层纱布覆盖,然后用绷带包裹严实,防止玉夫膏挥发和流失,保证玉夫膏与创面充分作用;4、裸露坏死的骨骼肌腱和皮肤在换药过程中予以清除,每天换药1次,直至创面愈合。
冯亚高,惠连旺,杨小冬,刘鸿舒. 玉夫膏在足部外伤难愈合创面修复中的应用Application of Yufu Cream in the Repair of Refractory Wounds of Foot Trauma[J]. 外科, 2022, 11(03): 88-94. https://doi.org/10.12677/HJS.2022.113015