嬰兒漏針造成深層傷口壞死處理－－案例報告

The Management of Deep Tissue Injury after Extravasation Injury in an Infant-a Case Report

點滴漏針的傷口處理在嬰幼兒的個案裡是相對棘手的挑戰，因為嬰幼兒的血管管徑細小、皮膚稚嫩易受傷害，如果遇到傷口壞死面積大、深度深、肌腱外露的嚴重個案，除了清創和敷料治療之外，可能還要考慮採取植皮和皮瓣手術，但是不適當的傷口照護會造成病患併發症變多，例如手腳的功能，而過長的住院過程往往會加重病童與家屬與醫師的焦慮，還有可能造成醫療糾紛與訴訟。我們要報告一個嬰兒漏針傷口個案的處理經驗，採取了負壓療法與特殊敷料（銀離子和膠原蛋自敷料）併用的治療法，是一個可以縮短傷口癒合時程（四週）、成效良好的輔助療法，也是植皮重建、皮瓣手術之外值得參考的替代方案。

Extravasation injury in neonates, infants, or children is complicated because of the small size of their vessels and vulnerable skin. Some severe cases need to be treated by skin graft transplantation or flap surgery. Inadequate wound care after extravasation injury comes with increased morbidity, for example, the dysfunction of extremities. Poor extravasation wound care may lead to motor and sensory dysfunction in the extremities. Prolonged hospitalization will also increase anxiety levels of the patients, families, and clinicians. Herein, we present case of extravasation injury in an infant who was managed using different adjuvant therapies. We used negative pressure wound therapy (NPWT) to increase wound granulation tissue after wound debridement. Collagen dressings and silver dressings were also used to promote epithelization. Perfect completed wound healing wound healing was achieved in 4 weeks. The use of these adjuvant therapies can help avoid the need for skin grafts or flap surgeries in such patients.