腋窝螺旋桨皮瓣整复腋窝皱襞瘢痕挛缩的临床效果  

Clinical effects of axillary propeller flaps in reconstructing the axillary fold scar contracture

作　　者：段梦婷 梁鹏飞[1] 张丕红[1] 张明华[1] 任利成[1] 吴英[1] 曾纪章[1] 郭乐 胡佳雄 崔旭[1] 黄覛韬 周思拓 黄晓元[1] Duan Mengting;Liang Pengfei;Zhang Pihong;Zhang Minghua;Ren Licheng;Wu Ying;Zeng Jizhang;Guo Le;Hu Jiaxiong;Cui Xu;Huang Mitao;Zhou Situo;Huang Xiaoyuan(Department of Burns and Plastic Surgery,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院烧伤整形科,长沙410008

出　　处：《中华烧伤杂志》2021年第4期377-381,共5页Chinese Journal of Burns

基　　金：国家自然科学基金面上项目(81974287);湖南省自然科学基金(2019JJ40527)。

摘　　要：目的探讨腋窝螺旋桨皮瓣整复腋窝皱襞瘢痕挛缩的临床效果。方法采用回顾性队列研究方法。2016年7月—2020年1月,中南大学湘雅医院收治11例腋窝前皱襞或前后皱襞烧伤后瘢痕挛缩患者,其中男7例、女4例,年龄8~48岁,病灶累及单侧腋窝9例、双侧腋窝2例,患肢肩关节外展25~100°。对腋窝皱襞挛缩瘢痕进行切除及松解,形成面积为8 cm×5 cm~24 cm×20 cm创面。根据腋窝残余正常皮肤的情况,设计面积为5 cm×3 cm~24 cm×10 cm的2、3、4叶螺旋桨皮瓣修复瘢痕切除及松解后形成的创面。供区创面直接拉拢缝合,不能完全缝合的残余创面游离移植大腿内侧或腹部全厚皮片。记录2、3、4叶螺旋桨皮瓣应用情况及术后即刻患侧肩关节外展角度,观察术后皮瓣和皮片成活情况,随访观察瘢痕挛缩复发情况、皮瓣外观、患侧肩关节外展角度、患侧肩关节及上臂功能恢复情况。结果本组11例患者移植的13个腋窝螺旋桨皮瓣中,双叶螺旋桨皮瓣9个、3叶螺旋桨皮瓣2个、4叶螺旋桨皮瓣2个。术后即刻患侧肩关节外展达110~165°。术后皮瓣全部成活;9个皮瓣供区游离移植皮片修复,术后7个供区皮片全部成活,2个供区切口瘢痕糜烂且移植皮片小块坏死,其中1个创面经清创后移植大腿内侧刃厚皮修复,1个创面经换药后愈合。术后随访6~24个月,所有患者腋窝瘢痕挛缩无复发;皮瓣颜色与受区匹配,弹性良好;患侧肩关节外展达120~165°,患侧肩关节旋前旋后、上臂上举及环转运动均良好。结论应用腋窝螺旋桨皮瓣整复腋窝皱襞瘢痕挛缩效果较佳,术后患者皮瓣外观较佳,肩关节的活动及上臂功能恢复较好。Objective To explore the clinical effects of axillary propeller flaps in reconstructing the axillary fold scar contracture.Methods A retrospective cohort study was conducted.From July 2016 to January 2020,11 patients with anterior axillary fold or anterior and posterior axillary fold scar contractures after burns were admitted to Xiangya Hospital of Central South University,including 7 males and 4 females,aged 8 to 48 years.The lesions involved unilateral axilla in 9 cases and bilateral axilla in 2 cases,with the joint abduction angle of the affected shoulder ranging from 25 to 100°.The axillary fold contracture scars were excised and released,resulting in wound of 8 cm×5 cm-24 cm×20 cm.According to the condition of the residual normal skin in axilla,2,3,and 4-leaf propeller flaps with area of 5 cm×3 cm-24 cm×10 cm were designed to repair the wounds after scar excision and release.The donor site wound was closed by suturing directly,and the residual wound that could not be completely sutured was transplanted with free full-thickness skin grafts from the inner thigh or abdomen.The application of 2,3,and 4-leaf propeller flaps,the joint abduction angle of the affected shoulder immediately after operation,and the survival of the flaps and skin grafts after operation were recorded.The recurrence of scar contracture,the appearance of the flaps,the joint abduction angle of the affected shoulder,and the functional recovery of the affected shoulder joint and upper arm were observed through a follow-up.Results Among the 13 axillary propeller flaps transplanted in the 11 patients in this group,there were 9 double-leaf propeller flaps,two 3-leaf propeller flaps,and two 4-leaf propeller flaps.The joint abduction angle of the affected shoulder reached 110-165°immediately after operation.All the flaps survived after operation.Nine flap donor sites were repaired with free skin grafts,with skin grafts survived in 7 flap donor sites after operation.Scar erosion in incision and small area of skin graft necrosis developed in

关 键 词：腋 外科皮瓣 瘢痕挛缩 

分 类 号：R644[医药卫生—外科学] R605[医药卫生—临床医学]