颈部瘢痕挛缩治疗方案的优化选择及临床效果分析  

Optimal selection of treatment scheme for cervical scar contracture and analysis of clinical efficacy

作　　者：唐银科 楚菲菲 丁健科 张钰 刘维 何强 马显杰 TANG Yin-ke;CHU Fei-fei;DING Jian-ke;ZHANG Yu;LIU Wei;HE Qiang;MA Xian-jie(Department of Plastic and Reconstruc­tive Surgery,The First Affiliated Hospital of Air Force Medical University,Xi'an 710032,China)

机构地区：[1]空军军医大学第一附属医院整形外科,陕西西安710032

出　　处：《中国美容整形外科杂志》2021年第11期644-646,665,共4页Chinese Journal of Aesthetic and Plastic Surgery

基　　金：国家自然科学基金(81971851,82172229)。

摘　　要：目的探讨颈部瘢痕挛缩修复方案的优化选择及临床效果。方法回顾性分析自2017年1月至2020年12月,空军军医大学第一附属医院整形外科收治的75例颈部瘢痕修复患者的临床资料。根据治疗要求,结合病变范围采用相应治疗方案,分为局部皮瓣组22例;局部扩张皮瓣组7例;邻位扩张皮瓣组29例(单侧扩张颈横皮瓣20例,双侧扩张颈横皮瓣3例,单侧扩张的胸三角皮瓣6例);植皮组17例,术中均对质硬瘢痕组织切除,充分松解瘢痕牵拉及挛缩,采用对应皮瓣或者皮片进行组织移植修复。结果术后所有皮片、皮瓣均成活,患者颈部瘢痕挛缩外观和功能均得到明显改善;随访3个月至2年,患者对颈部的外形及功能改善较满意,其中6例瘢痕修复后出现轻度皮片挛缩;29例采用胸前区扩张皮瓣移植修复的患者皮瓣未见明显挛缩,但头部后仰时皮瓣边缘出现纵向挛缩瘢痕,经Z形皮瓣修复后改善;其余患者未出现挛缩。结论依据相似性修复原则,结合颈部瘢痕严重程度及周围皮肤情况,较小瘢痕宜采用局部转移皮瓣修复。对大面积瘢痕挛缩优先采用颈横动脉颈段皮支扩张皮瓣等胸前区扩张皮瓣修复;对于无扩张条件者则采用植皮修复,均可取得较佳的修复效果。Objective To explore the optimal selection and clinical efficacy of treatment scheme for cervical scar contracture.Methods The clinical data of 75 patients with cervical scar contracture from January 2017 to December 2020 were analyzed retrospectively. According to the treatment requirement and the scope of lesion, patients were divided into local flap group(22 patients), local expanded skin flap group(7 patients), adjacent expanded skin flap(20 cases of unilateral expanded cutaneous branch of transverse carotid artery, 3 cases of bilateral cutaneous branch of transverse carotid artery and 6 cases of ipsilateral or contralateral thoracic deltoid flap, a total of 29 patients) and skin graft group(17 patients). During the operation, the hard scar tissue was excised, the scar traction and contracture were fully relieved, and the corresponding flap or skin graft was used to repair the tissue. Results All skin grafts and flaps survived, and the appearance and function of cervical scar contracture were significantly improved. After the follow-up from 3 months to 2 years, patients were satisfied with the improvement of cervical appearance and function. Slight skin graft contracture appeared in 6 patients after scar repaired. There was no obvious skin contracture in 29 patients repaired by expanded skin flap in the anterior thoracic region. Longitudinal scar contracture appeared at the edge of skin flap when head extensionand improved after Z flap repair. No scar contracture was found in remaining patients. Conclusion According to the principle of similarity repair, combined with the severity of cervical scar and surrounding skin condition, the liner scar should be repaired by local transfer skin flap. The extensive scar contracture should be repaired by expanded skin flap of cutaneous branch of transverse cervical artery. For patients without expansion condition, skin grafting could achieve good efficacy.

关 键 词：瘢痕 颈部 扩张术 皮瓣修复 

分 类 号：R622[医药卫生—整形外科]