穿支蒂皮瓣在躯干部瘢痕疙瘩治疗中的应用  

Application of perforator pedicled flap in the treatment of trunk keloids

作　　者：沈叶 郭伶俐[1] 王白石[1] 任静[1] 周博[1] Shen Ye;Guo Lingli;Wang Baishi;Ren Jing;Zhou Bo(Department of Plastic and Reconstructive Surgery,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院整形修复科,北京100853

出　　处：《中华整形外科杂志》2020年第8期887-892,共6页Chinese Journal of Plastic Surgery

基　　金：解放军总医院医疗大数据研发项目(2018MBD-022);全军医学科技青年培育项目(17QNP058)。

摘　　要：目的:探讨穿支蒂皮瓣在躯干部中、大型瘢痕疙瘩手术切除后创面修复中的应用效果。方法:2018年1月至2019年1月解放军总医院整形修复科收治躯干部中型以上瘢痕疙瘩患者10例,男2例,女8例,年龄20~53岁,胸前3例,脐部3例,下腹4例。瘢痕疙瘩大小2.0 cm×3.0 cm^5.0 cm×9.0 cm,病灶均伴有感染。手术彻底切除瘢痕及感染组织,松解挛缩,分别于创面周围设计以肋间穿支(3例)、脐旁穿支(3例)或腹股沟穿支为蒂的局部穿支(4例)蒂皮瓣,以推进或旋转方式覆盖创面。术后早期放疗,每日1次,每次5~10 Gy,连续3 d,总剂量约15~20 Gy。并辅以外用硅胶制剂、局部药物注射及弹力衣压迫等治疗。术后随访时应用温哥华量表评估瘢痕,同时分析评价局部形态、毛发分布、瘙痒、疼痛感及患者满意度。结果:术后皮瓣血运良好,切口均一期愈合。术后随访12~24个月,局部形态及毛发分布正常,瘙痒、疼痛感均明显缓解,9例患者温哥华量表评分1~6分,1例患者未遵医嘱按期随诊及辅助治疗,发生明显切口增生性瘢痕,温哥华量表评分9分。8例患者对治疗效果评价为非常满意,2例为满意。结论:局部穿支蒂皮瓣可以有效地修复躯干部中、大型瘢痕疙瘩手术切除后创面,联合早期放射治疗、外用硅胶制剂、弹力压迫等综合治疗可以达到较满意的临床效果。Objective To explore the application effect of perforator pedicle flap in the wound repair after resection of the medium and large-sized keloids in the trunk.Methods From January 2018 to January 2019,10 patients,aged from 20 to 53 years old,with medium and large-sized keloids in the trunk were treated,including 3 cases in the anterior chest,3 cases in the umbilical region,4 cases in the lower abdomen,8 cases were women and 2 cases were men.The size of keloids were 2.0 cm×3.0 cm to 5.0 cm×9.0 cm,and all keloids were accompanied with infection.Scars and infected tissues were removed and contracture was released completely.Pedicled flaps with intercostal perforator artery(3 cases),paraumbilical perforator artery(3 cases)or groin perforator artery(4 cases)were elevated and advanced or rotated to cover the wound.Early radiotherapy was delivered to the scar bed 5-10 Gy each time with a total dose of 15 to 20 Gy over 3 daily fractions after surgery.And other treatments,such as topical silicone gel,corticosteroid intralesional injection and elastic clothing compression were taken as adjuvant therapy.The scars were assessed by the Vancouver Scar Scale,and local morphology,hair distribution,itching,pain and patient satisfaction were analyzed and evaluated after 12 months to 24 months follow-up.Results All flaps survived and the incisions healed primarily.The local morphology and hair distribution were normal,and the itching and pain were relieved obviously.The Vancouver Scar Scale scores vary from 1 to 6 in 9 patients.Incision hypertrophic scar with the Vancouver Scar Scale score of 9 occurred in one noncompliance patient who didn’t follow up on time and refuse to take the adjuvant treatments.8 patients were extremely satisfied with the treatment effect,and 2 patients were satisfied with the treatment effect.Conclusions For medium and large-sized keloids in the trunk,combined modality therapy,including local perforator pedicled flaps transplantation,early radiotherapy,topical silicone gel,elastic compression and etc,wi

关 键 词：外科皮瓣 穿支皮瓣 皮瓣 带蒂 瘢痕疙瘩 综合疗法 

分 类 号：R622[医药卫生—整形外科]