连续Z形皮瓣联合瘢痕减容在儿童手部增生性瘢痕挛缩畸形治疗中的应用  

Application of continuous Z-flaps combined with scar debulking in the clinical treatment of hyperplastic scar contracture deformity of children’s hand

作　　者：於正福 沈卫民[1] 崔杰[1] 陈建兵[1] 韩涛[1] 严俊[1] 邹继军[1] Yu Zhengfu;Shen Weimin;Cui Jie;Chen Jianbing;Han Tao;Yan Jun;Zou Jijun(Department of Burn and Plastic Surgery,Children’s Hospital of Nanjing Medical University,Nanjing 210008,China)

机构地区：[1]南京医科大学附属儿童医院烧伤整形科,210008

出　　处：《中华整形外科杂志》2020年第10期1095-1099,共5页Chinese Journal of Plastic Surgery

摘　　要：目的探讨应用连续Z形皮瓣联合瘢痕减容矫正儿童手部增生性瘢痕挛缩畸形的效果。方法2016年1月至2018年12月,南京医科大学附属儿童医院烧伤整形科共收治27例手部烧、烫伤后瘢痕挛缩畸形患儿,共累及36个关节部位,男12例,女15例,年龄10个月至12.5岁,平均2.8岁。首先根据掌指关节或指间关节挛缩程度将其分为轻、中、重度,以此制定治疗方案。对轻、中度畸形,设计连续Z形皮瓣松解挛缩畸形,瘢痕减容后转移皮瓣关闭创面;对重度畸形,在连续Z形皮瓣彻底松解、瘢痕减容后转移皮瓣覆盖创面,残余创面行游离植皮。术后对患儿手部功能和外观进行随访观察。结果27例患儿手部36个关节部位中,轻度畸形12个,中度15个,重度9个,轻、中度畸形均未予游离植皮,重度畸形选择性地减少了植皮量,所有挛缩关节畸形均得到完全矫正。术后随访0.8~2.0年,均未再出现挛缩畸形,轻、中度患儿手部关节功能正常,皮瓣颜色、质地接近周围正常皮肤;重度患儿仅植皮部位有少量色素沉着。1例12.5岁的患儿因存活皮片弹性差、紧张感明显,在2年后再次行手术松解治疗,术后手指紧张感消失,效果满意。结论连续Z形皮瓣联合瘢痕减容可最大程度地保留瘢痕表面的皮肤,减少植量皮,为儿童手部增生性瘢痕挛缩畸形提供了一种较好的治疗方法,术后远期效果稳定。Objective To investigate the effect of continuous Z-flaps combined with scar debulking in correcting hyperplastic scar contracture deformity of children′s hand.Methods From January 2016 to December 2018,27 cases of children with scar contracture deformity after hand burn or scald were admitted to the Department of Burn and Plastic Surgery of Children′s Hospital of Nanjing Medical University,involving a total of 36 joint parts.12 male patients and 15 female patients aged 10 months to 12.5 years were divided into mild,moderate and severe types according to the contracture angle of metacarpophalangeal joints and interphalangeal joints,so as to make the treatment plan.The transposition of flaps for wound closure was designed for both mild and moderate cases after continuous Z-flaps to release contracture deformity with scar debulking.For severe deformity,the transposition of flaps should be conducted to cover the wound after the complete release by continuous Z-flaps and scar debulking,and the residual wound was covered by free skin grafts.The hand function and appearance were followed up after operation.Results In this study,12 of the 36 joints were mildly deformed,15 were moderately deformed,and 9 were severely deformed.No skin grafting was performed for mild and moderate deformities,and the amount of skin grafting was selectively reduced for severe deformities.All contracture joint deformities were completely corrected,with the follow-up period of 0.8-2.0 years,and no contracture deformities were found again.The hand joint function,skin flap color,texture of mild and moderate types were close to the surrounding normal skin.Severe type had only a small degree of pigmentation at the skin graft site.One 12.5-year-old child received second procedure 2 years later because of the poor elasticity of the skin graft and the tensions.The tension resolved after operation,with satisfactory results.Conclusions Continuous Z-flaps combined with scar debulking could maximize the retention of skin of the scar surface and reduc

关 键 词：瘢痕 肥大性 挛缩 手 儿童 Z成形术 瘢痕减容 

分 类 号：R726.5[医药卫生—儿科]