超长肩胛-侧胸-髂腹股沟联体皮瓣修复会阴部烧伤后瘢痕挛缩畸形  

REPAIR CONTRACTURE DEFORMITY OF PERINEAL SCAR CAUSED BY BURN WITH EXTRA LONG SCAPULAR-LATERAL THORACIC-ILIOINGUINAL SIAMESE FLAP

作　　者：杨敏烈[1] 赵庆国[1] 赵振民 吕国忠[1] 苏青和[1] 朱宇刚[1] 俞舜[1] 秦宏波[1] 

机构地区：[1]无锡市第三人民医院烧伤整形科,江苏无锡214041 [2]中国医学科学院北京整形外科医院唇腭裂中心

出　　处：《中国修复重建外科杂志》2010年第6期657-660,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨应用超长肩胛-侧胸-髂腹股沟联体皮瓣修复会阴部烧伤后瘢痕挛缩畸形的疗效及特点。方法 2008年1月-2009年8月,收治9例深Ⅱ～Ⅲ度烧伤后会阴部瘢痕挛缩畸形患者。男7例,女2例;年龄22～54岁,平均35.4岁。病程8个月～5年。均为会阴部中心型瘢痕,其中合并腹部瘢痕3例,双下肢瘢痕4例,腹部、双下肢瘢痕2例。瘢痕溃疡2例。双下肢外展(29.4±8.8)°。6例肛门不能暴露,蹲坐及大小便困难。术中瘢痕切除后缺损范围为20cm×6cm～28cm×8cm,采用大小为35cm×12cm～58cm×15cm的超长肩胛-侧胸-髂腹股沟联体皮瓣移位修复缺损。供区均直接拉拢缝合。结果术后1例皮瓣形成水疱和坏死,经换药后愈合;其余皮瓣均顺利成活,切口Ⅰ期愈合。供区切口均Ⅰ期愈合。术后9例均获随访,随访时间6～12个月。会阴部功能恢复良好,局部畸形矫正,双下肢外展至(75.6±11.3)°,与术前比较差异有统计学意义(P<0.05)。蹲坐及大小便功能恢复良好。2例于术后6个月局部再次发生会阴部瘢痕粘连,二期行瘢痕切除、扩张皮瓣移位修复术后无复发。结论超长肩胛-侧胸-髂腹股沟联体皮瓣供瓣范围大,移位灵活,血运稳定充足,移位后可作为扩张皮瓣再次利用,是修复会阴部烧伤后瘢痕挛缩畸形的较好方法之一。Objective To assess the efficacy of the extra long scapular-lateral thoracic-ilioinguinal siamese flap to repair the contracture deformity of perineal scar caused by burn and to discuss its characteristics.Methods From January 2008 to August 2009,9 patients with contracture deformity of perineal scar after deep Ⅱ degree to Ⅲ degree burn were treated.There were 7 males and 2 females aged from 22 to 54 years（35.4 years on average）.The course of disease ranged from 8 months to 5 years.All cases had central type of perineal scar.Among the cases,3 cases were complicated by abdominal scar,4 cases by legs scar,and 2 cases by abdominal and legs scar.Scar ulcer was observed in 2 cases.The opening-closing angle of bilateral lower extremities was（29.4 ± 8.8）°.And anus could not expose entirely so that squatting and relieving the bowels were difficult in 6 cases.Defect areas after scar resection ranged from 20 cm × 6 cm to 28 cm × 8 cm.The size of extra long scapular-lateral thoracic-ilioinguinal siamese flap ranged from 35 cm × 12 cm to 58 cm × 15 cm.The donor sites were sutured directly.Results Blister and necrosis occurred in 1 case and was cured after dressing changed,and others flaps survived with wounds primary healing.Incision at donor site healed by first intention.All cases were followed up 6-12 months.The perineal function improved and the partial deformities were corrected.The opening-closing angle of bilateral lower extremities increased to（75.6 ± 11.3）°,showing significant difference between pre-and post-operation（P 〈0.05）.The functions of squatting and relieving the bowels recovered well.The perineal scar adhesion recurred in 2 cases after 6 months of operation and were cured after scar resection and expanding flaps transposition.Conclusion In view of large donating region,great facility for transposition,stable and sufficient blood supply,reutilization as expanded flap,it was an effective treatment and a beneficial trial by applying the transposition of the extra long scapular-lat

关 键 词：会阴部瘢痕 挛缩畸形 超长联体皮瓣 修复 

分 类 号：R644[医药卫生—外科学]