小儿手烧伤后瘢痕挛缩畸形的手术方式选择  

Selection of surgical methods for postburn scar contracture deformity in children′s hands

作　　者：尹会男 柴家科 李峰 陈琦 尹振 孙英杰 陈鑫 杨洪美 Yin Huinan;Chai Jiake;Li Feng;Chen Qi;Yin Zhen;Sun Yingjie;Chen Xin;Yang Hongmei(Burns and Plastic Surgery Department, Fourth Medical Center of PLA General Hospital, Beijing 100048, China)

机构地区：[1]中国人民解放军总医院第四医学中心烧伤整形科,北京100048

出　　处：《中华整形外科杂志》2019年第5期451-455,共5页Chinese Journal of Plastic Surgery

基　　金：解放军总医院临床科研扶持基金(2017FC-304M-ZHCG-02).

摘　　要：目的探讨小儿手部烧伤后瘢痕挛缩畸形手术方式的选择。方法回顾性分析2014年1月至2018年1月解放军总医院第四医学中心烧伤整形科收治的33例小儿手部烧伤后瘢痕挛缩畸形患者的临床资料,其中男24例,女9例,年龄11个月至6岁7个月。33例患儿共42只手畸形,其中掌侧掌指关节瘢痕挛缩20只,掌侧指间关节瘢痕挛缩9只,背侧掌指关节瘢痕挛缩7只(爪形手3只),手背瘢痕挛缩3只,手掌瘢痕挛缩3只。36只手瘢痕切除后采用全厚皮片或中厚皮片移植,6只手因瘢痕切除后肌腱或骨质外露采用腹部皮瓣进行修复。结果 36只手皮片移植后2周,31只全部成活,3只成活率约90%,2只成活率约80%,经换药后全部愈合;6只手行瘢痕切除、腹部皮瓣修复术,术后皮瓣全部成活。随访1~2.5年,4只因手指又出现瘢痕挛缩,再次行瘢痕切除植皮治疗,3只因指蹼粘连行Z改形术,其余功能正常,未出现挛缩与功能障碍,皮片颜色与周围皮肤接近,部分存在色素沉着,质地接近正常皮肤,皮片边缘瘢痕不明显,腹部皮瓣修复的6只手功能正常,颜色、质地与周围皮肤接近,家属满意。结论大张自体皮片移植是目前小儿手烧伤后瘢痕挛缩主要的手术方式,如有肌腱或骨质外露,特别是创面大或部位较多时,可考虑使用腹部皮瓣修复。Objective To explore the surgical methods for children with contracture deformity on hands after burn. Methods From January 2014 to January 2018, 33 pediatric patients, a total of 42 hands with scar contracture deformities were reviewed. There were 24 males and 9 females, aged from 11 months to 6 years and 7 months. Among them, 20 hands were volar metacarpophalangeal joint contractures, 9 were volar interphalangeal joint contractures, 7 were dorsal metacarpophalangeal joint contractures (3 claw-shaped hands), 3 were hand back contractures, and 3 were palm contractures. Of the 42 hands, 36 hands were repaired with full-thickness skin grafts or split-thickness skin grafts, after the removal of contracted scar, and 6 hands were repaired with abdominal skin flaps, due to the tendon or bone exposure after the scar removal. Results Skin grafts on 31 hands were all survived after 2 weeks. However, the survival area of 3 skin grafts was about 90%, and 2 skin grafts survived about 80%. All of them healed well after dressing changing. The 6 hands repaired with abdominal skin flap healed well too. After 1-2.5 years of follow-up, finger scar contracture occurred in 4 hands with skin grafting, and they were performed scar excision and sheet skin grafting. Three hands were treated with Z-plasty, due to web space contracture. The function of other hands were normal, without contracture or deformity. The skin color and texture were similar to the surrounding skin, with limited pigmented. Scars on the edge of skin grafts was not obvious. Patients and their families were satisfied. Conclusions The sheet skin graft is the main method for postburn scar contracture in children′s hands. The abdominal skin flap should be considered, if tendon or bone is exposed, especially for large wound or multiple sites.

关 键 词：儿童 手 烧伤瘢痕挛缩 植皮术 外科皮瓣 下腹部皮瓣 

分 类 号：R726.5[医药卫生—儿科]