风筝样切口联合全厚皮片移植修复严重指蹼瘢痕挛缩畸形  

REPAIRING SEVERE CICATRICIAL CONTRACTURE DEFORMITY IN WEB-SPACE BY KITE-LIKE INCISION COMBINED WITH FULL-THICKNESS SKIN GRAFTING

作　　者：梁黎明[1] 柴家科[1] 贾晓明[1] 王祎蓉[2] 孟素玉 刘韬 

机构地区：[1]解放军总医院第一附属医院烧伤整形科,北京100048 [2]中国医学科学院北京协和医学院整形外科医院整形八科 [3]邢台市第五医院烧伤整形科 [4]乌海市人民医院烧伤整形科

出　　处：《中国修复重建外科杂志》2012年第12期1486-1488,共3页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨风筝样切口联合全厚皮片移植修复严重指蹼瘢痕挛缩畸形的疗效。方法 2008年6月-2011年9月,收治指蹼瘢痕挛缩畸形患者31例(87个指蹼)。男24例,女7例;年龄5～43岁,中位年龄22岁。致伤原因:火焰烧伤26例,热液烫伤3例,电弧烧伤1例,化学烧伤1例。损伤分度:深Ⅱ度14例,Ⅲ度17例。受伤至该次手术时间10个月～17年,中位时间2.2年。设计风筝样切口,切除相邻掌指关节间的菱形瘢痕并充分松解指蹼间瘢痕粘连,继发创面采用全厚皮片移植修复。供皮区拉拢缝合。结果术后全厚皮片均成活,供皮区切口Ⅰ期愈合。29例(82个指蹼)获随访;随访时间6～18个月,平均13个月。再造指蹼大小及深度均类似正常指蹼,无继发挛缩,各手指活动度良好。结论采用风筝样切口联合全厚皮片移植修复严重指蹼瘢痕挛缩畸形可获得较好近期疗效,远期疗效需进一步观察。Objective To investigate the effectiveness of repairing severe space by kite-like incision combined with full-thickness skin grafting. Methods cicatricial contracture deformity in the web- Between June 2008 and September 2011, 31 patients （87 web-spaces） with severe cicatricial contracture deformities in the web-spaces were treated. There were 24 males and 7 females, aged 5-43 years （median, 22 years）. The causes of injuries were flame burn （26 cases）, scald （3 cases）, electric arc burn （1 case）, and chemical burn （1 case）. The degree of burn was deep second degree （14 cases） and third degree （17 cases）. The interval time from injury to operation was 10 months to 17 years （median, 2.2 years）. The kite-like incision was marked on the scar in the web-space. The rhombic scar between the adjacent metacarpophalangeal joints was excised, and cicatricial contracture was released completely. The secondary wound in the web-space was repaired with full-thickness autogeneic skin grafting. The secondary wound at donor site was directly sutured. Results All full-thickness skin grafts survived well. The incisions at donor sites healed primarily. Of 31 patients, 29 （82 web-spaces） were followed up 6-18 months （mean, 13 months）. The sizes and depths of reconstructed web- spaces were similar to those of normal ones. No secondary cicatricial contracture was observed, and the function of fingers recovered well. Conclusion The short-term effectiveness is satisfactory by kite-like incision combined with full-thickness skin grafting for repairing severe cicatricial contracture deformities in the web-space, while the long-term effectiveness needs further observation.

关 键 词：指蹼瘢痕挛缩 风筝样切口 全厚皮片移植 

分 类 号：R644[医药卫生—外科学]