远位预扩张皮瓣修复颈部瘢痕挛缩畸形  

Repairing scar contracture in neck with distant fabricated expanded flaps

作　　者：周捷[1] 何亭[1] 张丕红[1] 张明华[1] 黄晓元[1] 

机构地区：[1]中南大学湘雅医院烧伤重建外科,湖南长沙410008

出　　处：《中国现代医学杂志》2014年第2期78-82,共5页China Journal of Modern Medicine

摘　　要：目的了解远位预扩张皮瓣修复颈部烧伤后瘢痕挛缩畸形的效果。方法利用13个皮肤扩张器对11例烧伤后颈部瘢痕挛缩畸形患者进行治疗。扩张器容量为200~600 mL。扩张时间3~5个月。扩张器置入部位大部分为正常皮肤,其中5个扩张器置入烧伤后稳定软化的瘢痕下。扩张后行皮瓣转移术,其中8例患者的扩张器置于斜方肌下部深筋膜层内,行以颈横动脉深支为蒂的远位扩张皮瓣移植,3例患者的扩张器置于锁骨下前胸部,预构胸廓内动脉胸前穿支为蒂的胸三角皮瓣。其中6例患者在行扩张器2期手术前行皮瓣延迟术。结果 11例患者术后皮瓣均成活,效果满意。术后均未发生血肿、感染等并发症。11例患者随访3-24个月,皮瓣颜色、质地均佳,外形及功能明显改善。结论远位预扩张皮瓣是治疗颈部烧伤后瘢痕挛缩畸形的可选方法之一。尤其在局部无正常可扩张利用皮肤的情况下,远位扩张以及扩张瘢痕皮肤也是良好的选择。[Objective] To investigate the resuh of repairing of scar contracture in neck regions with dis- tant fabricated expanded flaps. [Methods] 13 skin expanders with volume ranging from 200 to 600 mL were implanted into 11 patients with scar eontracture in neck regions after burn. The expansion time ranged i}om 3 to 5 months. Most expanders were implanted under normal skin. 5 expanders were implanted under stable in- tenerated scars after healing burn, and flaps were transplanted after expanding. Expanders in 8 patients were implanted under deep fascia layer of trapezius, and distant expanded flaps with deep branch of transverse cervical arteD＇ as pedicle were fabricated and transplanted. Expanders in 3 patients were implanted in the in- fraclavieular chest region, and expanded deltnpectnral flaps with chest branch of internal thoracic artery as pediele were tabricated and transplanted. Flap delay procedure was performed before the second-stage opera- tion in 6 patients. [Results] All flaps survived with satisfactory results. No complications including hematoma and infection occurred. 11 patients were all revisited for 3- 24 months. It was found that cnlor and texture of flaps were in good conditions; shape and thnction were obviously improved. [Conclusion] Distant fabricated flaps is a option for repairing scar eontracture in neck. Distant fabricated expanded flaps and expanded cica- trical flaps are good choices when nol-mal skin is deficient nearby.

关 键 词：烧伤 颈部 瘢痕 外科皮瓣 修复外科手术 扩张术 

分 类 号：R622.1[医药卫生—整形外科]