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Закрытие ожоговой раны
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Закрытие ожоговой раны

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by admin11.12.2014
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Все средства и методы, направленные на лечение обожженного, преследуют в конечном счете одну цель — превратить открытую, инфицированную ожоговую рану в чистую и закрытую, что достигается аутодермопластикой. Ожоговую рану следует закрыть как можно быстрее и с помощью наиболее показанных для каждого конкретного случая средств. Наличие грануляций в ране необязательно, хотя они, конечно, способствуют приживлению трансплантата. Чистая рана, освобожденная от некротической ткани и имеющая достаточную сосудистую сеть для обеспечения питания наложенного трансплантата, — основное условие для успешной операции. После иссечения некроза трансплантат можно накладывать и на чистую рану, поверхность которой представляет собой слой подкожной жировой ткани или надкостницу, хотя на ней нет никаких признаков развития капилляров. Успех аутодермопластики зависит от правильного определения «готовности» раны к трансплантации, выбора соответствующего трансплантата, надежной его фиксации и принятия мер, предотвращающих обезвоживание пересаженного лоскута.

Существует много способов свободной аутодермопластики, некоторые из них имеют лишь исторический интерес, как, например, пересадка небольших островков кожи по Янович-Чайнскому — Дейвису. Для окончательного закрытия раны берут аутодермотрансплантаты либо в виде цельного лоскута, либо, если площадь донорских участков ограничена, используют полоски кожи, марки, сетчатый трансплантат.

Марочный метод предусматривает приготовление расщепленных кожных трансплантатов в виде небольших квадратов, прямоугольников или треугольников, которые накладывают на рану так, что между ними остаются промежутки. Эти дефекты закрываются эпителием, разрастающимся с краев трансплантатов. Существует ряд показаний к применению этого метода пластики, которые в основном обусловлены ограниченностью ресурсов кожи, годной для пересадки. Основным недостатком метода является развитие гипертрофических рубцов на стыках трансплантатов.

При ожогах, занимающих до 25% поверхности тела, применимы аутогенные покрытия с обычной техникой трансплантации. Чаще для этой цели используют цельные расщепленные кожные трансплантаты, легче приживающие, а донорские места после снятия тонких лоскутов быстро реэпителизируются. Для взятия кожных трансплантатов существуют различного вида дерматомы, позволяющие срезать кожные лоскуты желаемой толщины. В нашей стране наибольшее распространение получили дисковые дерматомы (электрические и с ручным приводом). Наряду с ними выпускаются клеевые дерматомы и дерматомы с возвратно-поступательным механизмом действия.

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