烧创伤毁损性创面早期功能重建及外形修复  

Aesthentic repair and reconstruction of burns and tramatic damaged wounds

作　　者：雷晋[1] 侯春胜 郝振明[1] 段鹏[1] 

机构地区：[1]山西医科大学附属太钢总医院烧伤整形中心 山西省烧伤救治中心,太原030009

出　　处：《中华损伤与修复杂志（电子版）》2015年第1期13-17,共5页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

摘　　要：目的探索烧创伤毁损性创面在修复创面的同时早期功能重建与外形修复的方法。方法对2004年3月至2013年12月山西医科大学附属太钢总医院收治的97例各种原因导致的毁损性创面患者,在注重早期清创及创面处理质量基础上,运用美容美学理念、应用整形外科原则和技术,周密设计手术方案,皮瓣转移时,同期行肌腱移植等深部组织修复;应用游离、带蒂皮(肌)瓣中的筋膜、肌肉组织进行缺损区韧带、肌肉修复并封闭创面,利用预构皮瓣及复合组织移植再造缺损区功能及外形,早期邻近软组织预扩张技术一期修复软组织缺损骨外露及器官再造。结果 97例患者,其中一期清创后行局部皮瓣、轴型皮瓣、游离组织瓣修复17例。另清创后行封闭负压引流,应用带蒂、游离组织瓣预制、延期器官再造、功能重建80例,其中,肌腱移植+皮瓣移植11例;神经吻合3例,神经移植3例;利用组织瓣筋膜、肌腱修复髌韧带7例、修复半侧颜面毁损后鼻再造1例;早期软组织扩张皮瓣预置扩张修复骨缺损、外露及创伤性秃发19例;复合组织瓣预制唇龈沟重建,下颌缺损修复5例;热压伤分指袋状皮瓣保指术6例;阴囊/肛门修复再造4例;足跟踝部组织瓣修复21例,所有患者治疗后均达到保留和重建局部功能、外观较满意的修复效果。结论贯彻整形美容理念,"前移"整形外科手段,结合各种创面处理措施,是实现部分毁损性创面早期功能重建及外形修复的理想方法。Objective To explore the damage to the wound in repairing the at the same time,early functional reconstruction of the wound and shape repair methods. Methods Ninty-seven cases of damaged wounds admitted to General Hospital of Tisco,Shanxi Medical University from Mar. 2004 to Dec. 2013,caused by all sorts of reasons,on the basis of paying more attention to early debridement and wound treatment quality,using cosmetic aesthetic concept,application principle and technology,plastic surgery careful design operation plan and flap transfer,at the same time tendon transplantation,etc of deep tissue repair. Application free,（ muscle） pedicle skin flap of the fascia and muscle tissue defect,muscle ligament repair and closed wound,using pre constitutive flap and composite tissue transplants defect function and shape,early adjacent soft tissue expansion in advance technical issue to repair soft tissue defects of bone exposed and reproductive organs. Results Ninty-seven patients, the issue of local flap, axial flap debridement was retreating,free tissue flap to repair of 17 cases. Debridement after seal negative pressure drainage,the application of pedicle,free tissue flap prefabricated,delay the reproductive organs,functional reconstruction in 80 cases,among them,the tendon transplantation ＋ skin flap transplantation in 11 cases.Nerve anastomosis（ 3 cases）,nerve transplantation（ 3 cases）. Using tissue flap fascia,tendon repair patellar ligament in 7 cases,repair the damaged side face after nasal reconstruction in 1 case. Early soft tissue preset expansion expansion flap to repair bone defect,the leakage and 19 cases traumatic bald.Composite tissue flap prefabricated labial gingival groove reconstruction,5 cases of mandibular defect.Thermal injury refers to the pocket flap insurance refers to the operation 6 cases. Scrotal / anal repair reengineering 4 cases. Heel ankle tissue flap to repair 21 cases,all patients after treatment to reach the local function,appearance and reconstruction satisfactory repairing effe

关 键 词：创伤和损伤 外科 整形 外科皮瓣 修复外科手术 功能恢复 美学 

分 类 号：R644[医药卫生—外科学]