应用不同皮瓣修复手掌重度瘢痕挛缩畸形的临床分析  

EFFECTIVENESS OF DIFFERENT FLAPS FOR REPAIR OF SEVERE PALM SCAR CONTRACTURE DEFORMITY

作　　者：庞梦茹 肖海涛[1] 王怀胜[1] 刘晓雪[1] 陈俊杰[1] 岑瑛[1] 

机构地区：[1]四川大学华西医院烧伤整形科,成都610041

出　　处：《中国修复重建外科杂志》2016年第3期382-384,共3页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨应用不同皮瓣修复手掌重度瘢痕挛缩畸形的疗效。方法 2013年2月-2015年3月,收治手掌重度瘢痕挛缩畸形13例。其中男10例,女3例;年龄14~54岁,平均39岁。致伤原因:火焰烧伤、烫伤9例,热压伤2例,化学烧伤1例,电击伤1例。伤后至手术时间为6个月~6年,平均2.3年。术中充分切除、松解挛缩瘢痕及粘连的深部组织,恢复各指至伸直位,软组织缺损范围为6.0 cm×4.5 cm^17.0 cm×7.5 cm。采用桡动脉逆行岛状皮瓣(2例)、腹部带蒂皮瓣(4例)、游离胸背动脉穿支皮瓣(2例)、游离股前外侧皮瓣(1例)、游离肩胛皮瓣(4例)修复创面;皮瓣切取范围6.0 cm×4.5 cm^17.0 cm×7.5 cm。结果术后皮瓣全部成活。1例腹部带蒂皮瓣出现远端血运障碍,远端创面经换药后延迟愈合;其余患者创面均Ⅰ期愈合;供区植皮成活,切口均Ⅰ期愈合。13例患者均获随访,随访时间6~14个月,平均8个月。8例患者接受1~3次皮瓣修薄术。末次随访时患者手部功能均明显改善,外观满意。结论选用合适的皮瓣修复手掌重度瘢痕挛缩畸形能获得较好的治疗效果。Objective To evaluate the effectiveness of different flaps for repair of severe palm scar contracture deformity. Methods Between February 2013 and March 2015, thirteen cases of severe palm scar contracture deformity were included in the retrospective review. There were 10 males and 3 females, aged from 14 to 54 years（mean, 39 years）. The causes included burn in 9 cases, hot-crush injury in 2 cases, chemical burn in 1 case, and electric burn in 1 case. The disease duration was 6 months to 6 years（mean, 2.3 years）. After excising scar, releasing contracture and interrupting adherent muscle and tendon, the soft tissues and skin defects ranged from 6.0 cm×4.5 cm to 17.0 cm×7.5 cm. The radial artery retrograde island flap was used in 2 cases, the pedicled abdominal flaps in 4 cases, the thoracodorsal artery perforator flap in 2 cases, the anterolateral thigh flap in 1 case, and the scapular free flap in 4 cases. The size of flap ranged from 6.0 cm×4.5 cm to 17.0 cm×7.5 cm. Results All flaps survived well. Venous thrombosis of the pedicled abdominal flaps occurred in 1 case, which was cured after dressing change, and healing by first intention was obtained in the others. The mean follow-up time was 8 months（range, 6-14 months）. Eight cases underwent operation for 1-3 times to make the flap thinner. At last follow-up, the flaps had good color, and the results of appearance and function were satisfactory. Conclusion Severe palm scar contracture deformity can be effectively repaired by proper application of different flaps.

关 键 词：瘢痕挛缩 软组织缺损 游离皮瓣 带蒂皮瓣 岛状皮瓣 

分 类 号：R658.2[医药卫生—外科学]