皮肤软组织扩张术美容修复烧伤后头皮缺损合并颅骨外露  

Cosmetic repair of scald defect with skull exposure by skin soft tissue expansion after full-thickness burn

作　　者：张诚[1] 刘毅[1] 刘萍[1] 杨雪丽[1] 刘长海[1] 

机构地区：[1]兰州军区兰州总医院全军烧伤整形外科中心,甘肃兰州730050

出　　处：《中国美容医学》2009年第12期1717-1719,共3页Chinese Journal of Aesthetic Medicine

摘　　要：目的:探讨应用皮肤软组织扩张术一期修复头部深度烧伤所致头皮缺损和颅骨外露的可行性和实用性。方法:1998年～2008年,我科共收治14例严重烧伤后头皮缺损合并颅骨外露的患者,其中电击伤12例,煤气中毒昏迷后颞顶部煤炉灼伤2例。头皮缺损面积4cm×6cm～8cm×16cm,颅骨外露最小3cm×2cm,最大12cm×6cm。电击伤或深度烧伤后1～6月余,创面清洁换药后,无明显创周炎,术中碘伏纱布覆盖创面并缝合固定,应用圆形和肾形皮肤软组织扩张器,置于头皮帽状腱膜下层,其切口位于预扩张皮瓣的远端,剥离范围距离创缘不小于2cm。注水扩张时间为1～5月,扩张器埋置1～3只,注水扩张总容量300～900ml,扩张额外皮肤面积为缺损面积的1.5～2倍。术中将外露坏死颅骨外板予以清除;或者在颅骨外板上钻孔,等待肉芽生长后,再行预扩张皮瓣覆盖。将扩张器取出后,将皮瓣和腔隙内形成的纤维膜切断,以利于皮瓣延伸和转移,并放置负压引流。结果:扩张部位无1例发生感染;有2例预扩张面积不够,经头皮总动员覆盖头皮缺损创面;其中1例坏死颅骨清除不彻底,形成枕部窦道,经再次手术,清除死骨并行局部皮瓣转移手术,修复枕部窦道;1例颞骨外露创面经接力扩张修复。术后头皮毛发生长如常。结论:电击伤等所致头皮缺损合并颅骨外露创面,完全可以应用软组织扩张术形成的头皮预扩张皮瓣进行一次性美容修复,无须Ⅱ期解决秃发畸形问题,较传统方法有明显优点。Objective To investigate the feasibility and practicability of soft tissue expansion in the cosmetic repair of scald defect with skull exposure after full-thickness burn. Methods 14 patients of scald defect with skull exposure after full-thickness burn were accepted in our department from 1998 to 2008. Among them,12 cases were burned by high voltage electricity on the head. 2 cases were burned by hot stove after coma due to gas poisoning. The area of scald defect was 4cm×6cm to 8cm×16cm,and the area of skull exposure was 3cm×2cm to 12cm×6cm. After burn,debridement and clean dressing exchange were carried out,with the disappear of local inflammation,roundness or kidney -like tissue expanders were placed under the subgaleal layer after 1 to 6 months postburn. The wound was covered and sutured by iodine gauze before operation. The incision was chosen at distal end of the pre-expanding flap which would be designed to cover the defect area. And the expander should be placed 2cm distal to the border of the wound. The pre-expanding time lasted 1 to 5 months; 1 to 3 expanders were used in one patient; the total volume of affusion was 300～900ml. The average expanding area was 1.5～2 times of the defect area. The sequestra was removed or the surface of the exposed skull was drilled to culture granulation before the wound coverage by skin flap. The fiber membranes of the expanding flap were cut to make a favorite extending and an easy transfer. Vacuum suction drainage was placed under the flap after operation. Results No infection occurred at the expanding area,the expanding area was not enough for the covering of the skin defect in 2 cases,the defect area was covered by the total mobilization of the scald. The residual defect in 2 cases was covered by small split-thickness skin graft. A sinus formed in the occiput of a patient due to the uncompleted removing of the sequestra. It was repaired by local flap after redebridement. A temporal bone exposed wound was repaired by relay expansion technique. The hair in the re

关 键 词：头皮缺损 颅骨外露 电击伤 皮肤软组织扩张术 

分 类 号：R622[医药卫生—整形外科]