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Некрэктомия до фасции с немедленной трансплантацией
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Некрэктомия до фасции с немедленной трансплантацией

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by admin02.07.2015
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Некрэктомия до фасции с немедленной трансплантацией может применяться при глубоких ожогах. Иссечение ожогового струпа с помощью того или иного метода зависит от глубины поражения, его локализации и времени, прошедшего с момента ожога. При ожогах конечностей можно применять любой метод операции, поскольку для снижения кровопотери имеется возможность наложить жгут. При глубоких обширных ожогах туловища лучше применять иссечение до фасции или иссечение струпа с последующей подготовкой поверхности к трансплантации путем временного закрытия ее алло- или ксено-кожей. Тщательная оценка глубины поражения дает возможность индивидуально применить наиболее показанный метод операции, позволяет уменьшить число осложнений и предотвратить развитие инфекции, улучшить функциональные и косметические результаты, увеличить процент выживаемости среди больных с обширными ожогами.

Особенности проведения некрэктомии. Следует стремиться к максимальному сокращению времени операции. Обширную первичную некрэктомию следует проводить по крайней мере двумя бригадами хирургов. Одна из них обеспечивает взятие кожи с донорских участков и приготовление сетчатых трансплантатов, другая — проводит удаление ожогового струпа. R. Lewis и W. Quniby подчеркивают преимущество электрохирургической эксцизии струпа, которую эти авторы с успехом применяли как в раннем периоде ожога, так и в позднем. Эксцизию электроножом всей толщи кожи до фасции авторы производили под наркозом начиная с 3-го и до 13-го дня на площади в среднем до 40% поверхности тела. Благоприятный исход получен в большинстве случаев. Авторы подчеркивают положительные стороны использования электроножа: отсутствие каких-либо осложнений, уменьшение кровотечения и хорошее приживление трансплантатов.

Мы ожоговый струп иссекаем чаще скальпелем и электродерматомом. Для остановки кровотечения используем электрокоагуляцию и давящую повязку с солевым раствором.

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