侧胸腹部扩张皮瓣带蒂转移修复上肢组织缺损  

Repair of tissue defects in the upper extremities via expanded lateral thoracic abdominal skin flaps

作　　者：刘育凤[1] 黄金龙[1] 陈刚[1] 刘宁[1] 闻可[1] 王金明[1] 

机构地区：[1]江苏省中医院整形外科,江苏南京210029

出　　处：《中国美容整形外科杂志》2013年第10期596-599,共4页Chinese Journal of Aesthetic and Plastic Surgery

摘　　要：目的探讨应用侧胸腹部的扩张皮瓣修复上肢的组织缺损。方法本组患者共21例，埋置扩张器共31枚，扩张器容量300～600ml。上肢病变包括先天性黑毛痣5例，最大面积达体表面积的9％。16例上肢瘢痕涉及上肢不同部位。瘢痕大小占体表面积1％～2％。手术包括扩张器的埋置，Ⅱ期扩张器取出，皮瓣转移及断蒂术。并提出了一种简单的扩张皮瓣面积预测的方法。结果扩张器置入术后感染及扩张器外露各1例。扩张皮瓣转移后皮瓣远端1／3出现血供障碍1例。所有患者经过术后6个月至4年的随访，皮瓣颜色与上肢匹配，质地良好。儿童的转移皮瓣能随着发育生长，不影响肢体的发育。几乎所有患者在供区缝合部位及皮瓣与上肢的缝合部位出现增生性瘢痕，通过综合治疗，均萎缩或部分萎缩。结论侧胸腹部扩张皮瓣直接转移修复上肢缺损，较上肢扩张器埋置或植皮修复有更多的优点。Objective To explore the feasibility of the repair of tissue defects in the upper extremities via expanded lateral thoracic abdominal skin flaps. Methods We performed 31 expanded flaps in 21 patients. Original volume of tissue expander ranged from 300 ml to 600 ml. The soft tissue defects in the upper extremi- ties resulting from giant congenital pigmented nevi and the varied extensive scars are in 5 and 16, respectively. 9% body surface area was affected in a patient with giant congenital pigmented nevi. Scars area ranged from 1% to 2% body surface area, among them, 1 case needed 3 rounds. Tissue expander implanting, direct trans- ferring of expanded flap and flap pedicle separation is the same in all patients. A simple method of definiting the expander volume based on the specific patient were presented in the paper. Results Infection and extru- sion of expander occurred in 1 case, respectively. The distal one third part of the transferred flap presented a poor blood supply, which led to flap sporadic necrosis in 1 case. A good color match and texture were showed in the affected upper limb in all patients after a 6-month to 4-year follow-up. The transferred flap grew up as the body development in child. All patients suffered hypertrophic scars in the donor site and upper limb from high tension closing. It is necessary to treat it with silicone gel combining elastic pressure. Conclusion The ex- panded flap from lateral abdomen thorax are used to resurface the upper limb defect has advantage over tradi- tional skin grafting or the local expanded flap.

关 键 词：扩张器 上肢黑毛痣 上肢瘢痕 

分 类 号：R622[医药卫生—整形外科]