矩形瘢痕瓣联合移植自体刃厚皮片修复大面积烧伤后Ⅳ型腋窝瘢痕挛缩畸形  

Reconstruction of typeⅣaxillary scar contracture with rectangular scar flap combined with autologous thinning split-thickness skin graft

作　　者：龙忠恒 徐培 张红玲 曾静 高虎 唐诚 张祥明 Long Zhongheng;Xu Pei;Zhang Hongling;Zeng Jing;Gao Hu;Tang Cheng;Zhang Xiangming(Department of Skin Wound Repair Center,Tongren Hospital of Wuhan University&Wuhan Third Hospital,Wuhan 430070,China;Department of Traditional Chinise Medicine,Tongren Hospital of Wuhan University&Wuhan Third Hospital,Wuhan 430070,China)

机构地区：[1]武汉大学同仁医院暨武汉市第三医院皮肤创面修复中心,武汉430070 [2]武汉大学同仁医院暨武汉市第三医院中医科,武汉430070

出　　处：《中华整形外科杂志》2022年第2期191-195,共5页Chinese Journal of Plastic Surgery

摘　　要：目的探讨应用矩形瘢痕瓣联合移植自体刃厚皮片修复大面积烧伤后Ⅳ型腋窝瘢痕挛缩畸形的临床效果。方法选择2015年1月至2019年1月,武汉市第三医院皮肤创面修复中心收治的大面积烧伤后Ⅳ型腋窝瘢痕挛缩畸形患者,采用矩形瘢痕瓣重建腋窝区,短边上Y切口松解瘢痕,皮瓣形成后的裸露创面移植自体刃厚皮片。术后随访观察移植皮片的增生及挛缩、矩形瘢痕瓣的面积、腋窝外形及残余腋毛生长状况、肩关节活动范围。结果共选择6例,男2例,女4例,年龄18~58岁,瘢痕挛缩畸形时间1~23年。6例患者矩形瘢痕瓣全部成活。随访18个月至3年,腋窝瘢痕增生不明显,皮片挛缩程度轻。术后18个月时,所有患者肩关节外展上举可达到180°,肩关节旋转正常,腋窝外形、残余腋毛生长等满意,患者生活自理能力及生活质量提高。结论对于大面积烧伤自体皮源匮乏的患者,矩形瘢痕瓣联合移植自体刃厚皮片是修复Ⅳ型腋窝瘢痕挛缩畸形的良好方法。Objective To investigate the clinical effect of rectangular scar flap combined with autologous thinning split-thickness skin graft for repairing typeⅣaxillary scar contracture deformity after extensive burns.Methods From January 2015 to January 2019,patients with typeⅣaxillary scar contracture deformity after extensive burns were admitted to the Department of Skin Wound Repair Center of Wuhan Third Hospital.Rectangular scar flaps were used to reconstruct the axillary area,Y-shaped incision was made on the short side to release the scar,the resulting defects after flap formation were repaired with autologous split-thickness skin grafts.The hyperplasia and contracture of the grafted skin,the size of rectangular scar flap,the appearance of axilla,the growth of residual axillary hair,and the range of motion of shoulder joint were observed during the follow-up of 18 months to 3 years.Results A total of 6 cases were selected,including 2 males and 4 females,aged from 18 to 58 years,with the duration of scar contracture deformity ranging from 1 to 23 years.The rectangular scar flaps of all 6 patients survived.At the follow-up of 18 months to 3 years,the axillary scar hyperplasia and the skin graft contracture were mild.At 18 months after operation,the function of shoulder joint was restored with 180°shoulder abduction and lifting.Axillary appearance and residual axillary hair growth were satisfactory,the self-care ability and the quality of life of patients improved.Conclusions Rectangular scar flap combined with autologous thinning split-thickness skin graft is a good method for repairing typeⅣaxillary scar contracture in patients with lack of autologous skin sources for extensive burns.

关 键 词：瘢痕 烧伤 腋窝 瘢痕组织瓣 刃厚皮片 

分 类 号：R644[医药卫生—外科学]