继发于儿童时期烧伤的严重颈部畸形的修复  

Treatment for the cervical deformity secondary to burn in childhood

作　　者：王雪[1] 钱云良[1] 杨军[1] 张余光[1] 王丹茹[1] 

机构地区：[1]上海交通大学医学院附属第九人民医院整复外科,200011

出　　处：《中华损伤与修复杂志（电子版）》2011年第6期28-31,共4页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

摘　　要：目的通过运用游离复合肩胛皮瓣联合骨组织修复,从功能和美学标准方面修复继发于儿童时期烧伤的严重颈部挛缩畸形。方法回顾性分析2006-2010年上海交通大学医学院附属第九人民医院收治的儿童时期烧伤后继发重度颈部畸形患者42例,通过瘢痕切除松解和颈部成形术彻底松解颈部挛缩、加深颌颈角。根据术前头部影像学测量结果,选择带血供的肩胛骨移植,或者颏前移成形术来修复骨结构畸形,软组织缺损是按照涉及到的颈部美学亚单位来选择单叶或双叶肩胛皮瓣。术后通过颈部活动度和颌颈角来评估功能和外观效果。结果 42例患者颈部瘢痕挛缩松解后,有18例接受肩胛骨外侧缘骨移植,选用肩胛或肩胛/肩胛旁双叶皮瓣覆盖;10例由于烧伤后瘢痕未明显阻碍下颌骨发育,仅应用肩胛/肩胛旁双叶皮瓣覆盖缺损创面。另有21例接受颏前移成形术,选用肩胛或肩胛/肩胛旁双叶皮瓣覆盖缺损。所有皮瓣成活。颈部活动度良好,术后颌颈角恢复到90°～120°。供区由断层皮片覆盖,在长期随访中未见挛缩复发。结论游离的复合肩胛皮瓣十分适合用来修复儿童时期烧伤后继发重度颈部挛缩。在下颌骨发育严重畸形的患者应同时运用颏前移成形术或肩胛骨移植术以进一步加深颌颈角。Objective A free composite scapular flap, together with repairation of bone structure, was used both functionally and aesthetically, for postburn cervical contractures in childhood. Methods Forty-two patients were retrospectively studied who suffered from postburn cervical contraction in childhoood and accepted treatment in the department during the period of 2006-2010. The complete release of a cervical contracture was achieved by scar excision and cervicoplasty, which deepened the cervicomental angle and further prevented contracture recurrence. Based on preoperative cephalometric measurements, either vasculatized scapular bone grafting or sliding genioplasty was performed. Subsequently, the neck defect was resurfaced with either a traditional single or a bilobed free scapular flap depending on the aesthetic cervical subunits involved. Functional and aesthetic outcomes with respect to neck movement and cervicomental angle were assessed. Results All the 42 adolescent or adult patients with severe neck deformities secondary to childhood burn were treated. A bilobed scapular or parascapular flap with or without the lateral border of scapular bone was used in 14 cases. A bilobed scapular or parascapular flap was uesed in 10 cases whose development of mandibles was not restricted obviously. Sliding genioplasty with single scapular or bilobed scapular flap coverage was used in 18 cases. All flaps survived with no major complications. Range of motion for the neck was succuessfully achieved, permitting flexion, extension, rotation, and lateral bending. The cervicomental angle was improved in all cases with postoperative measurements ranging from 90 to 120 degrees. The donor sites was treated with a split-thickness skin graft without major morbidity. There were no contracture recurrences at long-term follow up. Conclusions For severe cervical vontractures due to burns in childhood, the application of a free composite scapular flap can provide the soft tissue and bony components necessary for adequate reconstruction of t

关 键 词：外科皮瓣 瘢痕 挛缩 颈部 修复外科手术 

分 类 号：R726.2[医药卫生—儿科]