以旋肩胛动脉为蒂的肩胛区皮瓣整复烧伤后腋窝瘢痕挛缩的临床效果  

Clinical effects of scapular region flaps pedicled with circumflex scapular artery in the reconstruction of axillary burn scar contractures

作　　者：李杉珊 朱珊 臧梦青 陈博 韩婷璐 谢婷珺 刘元波 Li Shanshan;Zhu Shan;Zang Mengqing;Chen Bo;Han Tinglu;Xie Tingjun;Liu Yuanbo(Department of Plastic and Reconstructive Surgery,Plastic Surgery Hospital,Peking Union Medical College and Chinese Academy of Medical Sciences,Beijing 100144,China)

机构地区：[1]中国医学科学院,北京协和医学院整形外科医院整形重建外科,100144

出　　处：《中华烧伤杂志》2019年第6期423-427,共5页Chinese Journal of Burns

摘　　要：目的探讨以旋肩胛动脉为蒂的肩胛区皮瓣整复烧伤后腋窝瘢痕挛缩的临床效果。方法2008年12月—2018年12月,笔者单位收治21例烧伤后腋窝瘢痕挛缩患者,其中男12例、女9例;年龄2~48岁,平均17.4岁;依据腋窝瘢痕挛缩的特点,分为Ⅰ型5例、Ⅱ型2例、Ⅲ型5例、Ⅳ型9例;术前肩关节外展角度为20~150°,平均68.33°。瘢痕挛缩切除、松解后创面面积为12cm×4cm^33cm×11cm,平均18.13cm×5.41cm,采用以旋肩胛动脉为蒂的肩胛区皮瓣修复,皮瓣面积为14cm×5cm^35cm×14cm,平均20.19cm×7.71cm。5例患者皮瓣修复术前对皮瓣供区进行扩张,16例患者直接转移皮瓣。供瓣区直接拉拢缝合。统计采用肩胛区皮瓣的类型、数量及转移方式,观察术后随访时肩关节外展角度改善情况及皮瓣情况。结果本组患者采用向上延伸的肩胛皮瓣5个、肩胛皮瓣13个、肩胛旁皮瓣3个。通过明道转移皮瓣18个,皮下隧道转移皮瓣1个,三边孔转移皮瓣2个。术后皮瓣全部成活,术后随访3个月~5年,平均19.4个月,肩关节外展角度为90~180°,平均137.62°,肩关节外展功能明显改善;皮瓣质地柔软,色泽与周围皮肤相近,患者和/或家属对手术效果满意。结论以旋肩胛动脉为蒂的肩胛区皮瓣具有血管蒂长、切取方便、供区隐蔽、转移方式灵活等优点,是临床整复严重烧伤后腋窝瘢痕挛缩的有效方法之一。Objective To explore the clinical effects of scapular region flaps pedicled with circumflex scapular artery in the reconstruction of axillary burn scar contractures.Methods From December 2008 to December 2018,21 patients with axillary burn scar contractures were admitted to our department.There were 12 male patients and 9 female patients,aged 2-48 years,with an average of 17.4 years.According to the characteristics of axillary scar contractures,the patients were divided into typeⅠof 5 patients,typeⅡof 2 patients,typeⅢof 5 patients,and typeⅣof 9 patients.The preoperative abduction ranges of shoulder joint were 20-150°,with an average of 68.33°.The wound areas after resection and release of scar contractures ranged from 12 cm×4 cm to 33 cm×11 cm,with an average of 18.13 cm×5.41 cm,and the wounds were repaired with scapular region flaps pedicled with circumflex scapular artery in the areas of 14 cm×5 cm-35 cm×14 cm,with an average of 20.19 cm×7.71 cm.The donor sites of 5 patients were expanded prior to flap repair operation,and the other 16 patients were repaired by direct transfer of flaps.The donor sites were closed directly.The type,number,and transfer way of scapular region flaps were calculated,and the improvement of abduction angle of shoulder joint and condition of the flaps were observed during follow-up after operation.Results There were 5 ascending scapular flaps,13 scapular flaps,and 3 parascapular flaps.The flaps were transferred through open wounds in 18 cases,subcutaneous tunnel in 1 case,and trilateral foramia in the remaining 2 cases.All the flaps survived after operation.During follow-up of 3 months to 5 years,with an average of 19.4 months,the abduction angles of shoulder joints were 90-180°,with an average of 137.62°,which showed that the abduction function of shoulder joint improved obviously.The texture of flap was soft,and the color of the flap was close to the surrounding skin.The patients and/or their family members were satisfied with the operation results.Conclusions The s

关 键 词：烧伤 腋 瘢痕 挛缩 旋肩胛动脉 肩胛皮瓣 

分 类 号：R644[医药卫生—外科学] R622[医药卫生—临床医学]