局部皮瓣交错结合自体中厚皮移植在关节部位瘢痕挛缩修复中的应用  

Application of interlaced local skin flaps combined with autologous medium-thickness skin grafting in the repair of joint scar contracture

作　　者：张万福 徐婧 韩飞 胡晓龙 李少珲 袁泽兵 胡大海 韩军涛 官浩 Zhang Wanfu;Xu Jing;Han Fei;Hu Xiaolong;Li Shaohui;Yuan Zebing;Hu Dahai;Han Juntao;Guan Hao(Department of Burns and Cutaneous Surgery,First Affiliated Hospital of Air Force Military Medical University,Xi′an 710032,China;Department of Surgery,People′s Hospital of Langao County,Shanxi Province,Ankang 725400,China)

机构地区：[1]空军军医大学第一附属医院烧伤与皮肤外科,西安710032 [2]陕西省岚皋县人民医院外科,725400

出　　处：《中华损伤与修复杂志（电子版）》2021年第1期34-38,共5页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

基　　金：国家自然科学基金应急管理项目(81741105)。

摘　　要：目的探讨局部皮瓣交错结合自体中厚皮移植在关节部位瘢痕挛缩修复中的应用效果。方法回顾性分析空军军医大学第一附属医院烧伤与皮肤外科2015年1月至2019年1月收治的烧烫伤致关节部位瘢痕挛缩患者80例,根据登记号分组,单号为对照组,双号为观察组,每组40例。2组患者均在行瘢痕松解后行创面修复。观察组患者测量关节部位形成创面的间距,沿两侧正常皮肤相反方向对应设计三角形皮瓣,剥离皮瓣后旋转90°,2个皮瓣交错对合,完整覆盖关节部位,皮瓣剥离后形成的上下2个创面,于背部或大腿外侧取自体中厚皮移植覆盖。对照组创面按照传统治疗方法,直接于背部或大腿外侧取大张自体中厚皮移植覆盖。门诊或网络随访6个月,观察2组患者临床治疗效果,计算2组治疗总有效率,统计2组术后抗瘢痕治疗时间及患者满意度评分,数据比较采用t检验和χ2检验。结果观察组治愈28例(70.0%),有效11例(27.5%),无效1例(2.5%);对照组治愈20例(50.0%),有效14例(35.0%),无效6例(15.0%),观察组治疗总有效率97.5%,高于对照组85.0%,差异有统计学意义(χ2=5.102,P<0.05);观察组患者术后抗瘢痕治疗时间(41.93±8.16)d,低于对照组[(64.17±11.35)d],患者满意度评分(91.34±13.75)分高于对照组[(79.33±9.04)分],差异均有统计学意义(t=14.742、11.102,P<0.05)。结论局部皮瓣交错结合分区中厚植皮为关节部位瘢痕挛缩的修复提供了一种较佳选择,术后术区外形好,瘢痕挛缩轻,预后功能好,可作为传统关节部位瘢痕松解后自体中厚植皮治疗的有益补充。Objective To explore the application effect of interlacing local skin flaps combined with autologous medium-thickness skin grafting in the repair of scar contractures in joints.Methods From January 2015 to January 2019,80 cases of patients with scar contracture of the joint caused by burn were treated in the Department of Burns and Cutaneous Surgery of First Affiliated Hospital of Air Force Military Medical University.All patients were grouped according to the registration number,the single number was the control group,and the double number was observation group,40 cases in each group.In both groups,the wounds were repaired after the scar was released.In the observation group,the spacing of the wound formed at the joint site was measured,and triangular flaps were designed in the opposite direction of the normal skin on both sides.After the flaps were removed,the flaps were rotated 90°,and the two flaps were staggered and conjuncted to completely cover the joint site.The upper and lower wounds formed after the peeled off of skin flap were covered with medium thickness skin grafts from the back or lateral thigh.The wounds in the control group were covered by large autologous medium thickness skin grafts directly on the back or lateral thigh according to the traditional treatment method.Follow-up for 6 months in the outpatient clinic or online,the clinical treatment effect of the 2 groups of patients were observed,the total effective rate,the postoperative anti-scar treatment time and patients satisfaction score of the 2 groups were calculated.Data were compared with t test and chi-square test.Results In the observation group,28 cases were cured(70.0%),11 cases were effective(27.5%),1 case was ineffective(2.5%);20 cases in the control group were cured(50.0%),14 cases were effective(35.0%),and 6 cases were ineffective(15.0%),the total effective rate of the observation group was 97.5%,which was higher than 85.0%of the control group,and the differences was statistically significant(χ2=5.102,P<0.05).The postoperative

关 键 词：瘢痕 关节挛缩 外科皮瓣 植皮 

分 类 号：R622[医药卫生—整形外科]