预扩张胸三角皮瓣修复面颈部瘢痕的效果评价  

Evaluation of the postoperative effect of pre-expanded pedicled deltopectoral flap on repairing facial-cervical scars

作　　者：王占统 余州 丁健科 唐银科 苏映军 李杨 马显杰 Wang Zhantong;Yu Zhou;Ding Jianke;Tang Yinke;Su Yingjun;Li Yang;Ma Xianjie(Department of Plastic and Reconstructive Surgery,First Affiliated Hospital of Air Force Medical University(Xijing Hospital),Xi′an 710032,China)

机构地区：[1]空军军医大学第一附属医院(西京医院)整形外科,西安710032

出　　处：《中华整形外科杂志》2019年第10期953-960,共8页Chinese Journal of Plastic Surgery

基　　金：国家自然科学基金(81671925,81971851);陕西省重点研发计划项目(2018ZDXM-SF-081)。

摘　　要：目的探讨预扩张胸三角皮瓣修复面颈部瘢痕术后的功能恢复情况及美容效果。方法对2008年1月至2018年12月空军军医大学西京医院整形外科收治的、行预扩张胸三角皮瓣修复面颈部瘢痕的42例患者56个皮瓣进行随访,其中男18例,女24例,年龄(24.7±7.3)岁,术后至少随访6个月,对各项指标进行测试和评估。使用浸入不同水温的玻璃试管接触皮瓣测试温度觉,以27 G钝针轻刺皮瓣测试痛觉,应用Semmes-Weinstein尼龙单丝测试触觉,应用Disk-Criminator测量两点辨距觉;应用CK-MC?960对皮瓣弹性进行测量;应用ANTERA?3D分析皮瓣颜色,包括L*a*b*值、黑色素和血红蛋白相对含量;采用患者与观察者瘢痕评估量表(POSAS)评估术后瘢痕;根据术后即刻与随访时的皮瓣面积计算回缩率;调查患者、医生及第三方的满意度。采用SPSS 23.0对数据进行统计学分析,满意度以百分数表示,瘢痕评分比较采用秩和检验,皮瓣与正常皮肤之间的弹性、L*a*b*值、黑色素和血红蛋白相对含量比较采用配对t检验,以P<0.05表示差异具有统计学意义。结果术后皮瓣的痛觉、温觉和冷觉的评分依次为(4.61±0.78)分、(3.48±0.90)分和(4.39±0.81)分,触觉阈为(0.26±0.23)g/mm2,两点辨距觉为(10.09±4.79)mm;皮瓣弹性、b*值和黑色素相对含量与面颈部正常皮肤相比,差异无统计学意义(P>0.05);皮瓣L*值、a*值和血红蛋白相对含量与面颈部正常皮肤相比,差异具有统计学意义(P<0.05)。POSAS患者自评结果显示,面部与胸部供区瘢痕在疼痛、瘙痒和硬度方面的差异均有统计学意义(P<0.05);观察者评价结果显示,面部皮瓣周围的瘢痕评分均优于胸部供区的瘢痕评分,差异均具有统计学意义(P<0.05)。皮瓣回缩率为(10.44±3.36)%。术后医、患双方及第三方的满意度分别为92.86%(39/42)、71.43%(30/42)和61.90%(26/42)。结论预扩张胸三角皮瓣修复面颈部瘢痕,术后功能恢复良好,具�Objective To investigate the functional recovery and cosmetic effects of pre-expanded pedicled deltopectoral flap.Methods From January 2008 to December 2018,42 patients with 56 pre-expanded pedicled deltopectoral flaps from Xijing Hospital of Air Force Military Medical University were followed up at least 6 months.18 of them were male,the remaining were female.And the average age was(24.7±7.3)years.Then the indicators were tested and evaluated.Tubes with different temperatures were used for temperature sensation test.The flaps were stabbed using a 27 G blunt needle to test algesthesia.Tactile threshold was measured by Semmes-Weinstein monofilament.Two-point discrimination was measured by Disk-Criminator.Elasticity of skin flaps was measured by CK-MC?960.Colors of skin flaps were analyzed by ANTERA?3D system,including L*a*b*,melanin and hemoglobin content.And the postoperative scars were evaluated by the Patient and Observer Scar Assessment Scale(POSAS).The flap retraction rate[(flap area immediately after operation-flap area at the follow-up time)/flap area immediately after operation]was calculated.The satisfaction of patients,doctors and third parties was investigated as well.Statistical analysis of data was performed with SPSS 23.0,satisfaction rate was expressed as percentages.Scar scores were compared by Wilcoxon rank sum test.The values of elasticity,color L*a*b*,melanin and hemoglobin between skin flaps and normal skin were analyzed by paired t test.The difference was statistically significant at P<0.05.Results The scores of pain,heat and cold sensation were(4.61±0.78),(3.48±0.90)and(4.39±0.81),the tactile threshold was(0.26±0.23)g/mm2,and the distance of two-point discrimination was(10.09±4.79)mm.There was no significant difference in elasticity,color b*and melanin content between skin flap and normal skin of face and neck(P>0.05).The color of flap L*,a*and hemoglobin content of flaps were significantly different from those of normal skin from face and neck(P<0.05).The result of self-assessment of p

关 键 词：外科皮瓣 皮肤软组织扩张术 面部 颈部 瘢痕 感觉 弹性 颜色 量表 术后满意度 

分 类 号：R47[医药卫生—护理学]