超薄瘢痕瓣联合放射治疗躯干和四肢瘢痕疙瘩的临床观察  

Clinical observation of super-thin scar flap combined with radiotherapy in the treatment of keloid in trunk and extremities

作　　者：王玉龙 周莉萍[1] 张文浩[1] 韩景健[3] 张志华 WANG Yulong;ZHOU Liping;ZHANG Wenhao;HAN Jingjian;ZHANG Zhihua(Department of Burn and Plastic Surgery,Jining First People's Hospital,Jining 272000,China)

机构地区：[1]济宁市第一人民医院烧伤整形外科,山东济宁272000 [2]苏州大学附属第二医院整形外科,江苏苏州215000 [3]济宁市第一人民医院医学美容中心,山东济宁272000

出　　处：《中国美容整形外科杂志》2022年第11期650-653,共4页Chinese Journal of Aesthetic and Plastic Surgery

摘　　要：目的探讨躯干和四肢部位中、大型瘢痕疙瘩切除后采用超薄瘢痕瓣修复创面的可行性及临床效果。方法自2018年10月至2020年11月,济宁市第一人民医院烧伤整形外科收治17例躯干背侧和四肢部位中、大型瘢痕疙瘩患者,肩背部8例,四肢9例,其中4例合并化脓性感染病灶。瘢痕疙瘩大小2.0 cm×6.0 cm~5.0 cm×15.0 cm。手术沿瘢痕疙瘩长轴中央全长切开,从切口分别向两侧锐性剥离,保留瘢痕瓣厚度1.5~2.0 mm,剥离范围至瘢痕疙瘩与正常组织交界处,将瘢痕瓣下的瘢痕组织及感染病灶彻底切除,直接间断缝合瘢痕瓣切口封闭创面。16例成年患者术后24 h内接受浅层电子线放射治疗,其中10例放射治疗结束后,术区给予负压封闭引流(vacuum sealing drainage,VSD)治疗10 d;1例患儿术后即刻给予VSD治疗,持续14 d。结果17例患者术后14~21 d切口愈合,16例采用电子线放射治疗的患者,瘢痕瓣浅层出现不同程度的局灶性坏死,未影响瘢痕瓣成活及创面修复。随访11~30个月,所有患者切口瘢痕无增生;瘢痕边缘小范围复发灶局部注射曲安奈德后控制良好;16例辅以放射治疗的患者,随着时间延长,保留的病理性瘢痕皮肤逐渐恢复至普通瘢痕皮肤。结论采用超薄瘢痕瓣修复躯干和四肢中、大型瘢痕疙瘩切除创面,具有可行性,因不增加切取皮瓣或皮片引发的供区创面,该方法有较积极的临床意义。Objective To explore the feasibility and clinical efficacy of super-thin scar flap in the repair of wounds in trunk and extremities after medium-sized or large keloid resection.Methods From October 2018 to November 2020,17 patients with medium-sized or large keloids in trunk and extremities were treated in the Department of Burn and Plastic Surgery of Jining First People’s Hospital,including 8 cases of shoulder and back and 9 case of extremities.The size of keloid was from 2.0 cm×6.0 cm to 5.0 cm×15.0 cm.The operation was performed along the central part of the long axis of keloid,and sharp dissection was made to both sides.The thickness of scar flap was from 1.5 to 2.0 mm.The scar tissue under the scar flap and the infection were completely removed,and the incision of the scar flap was closed by interrupted suture.Sixteen adult patients received superficial electron beam radiotherapy within 24 hours after operation.Ten patients received vacuum sealing drainage(VSD)treatment for 10 days after radiotherapy,and 1 child received VSD treatment for14 days immediately after operation.Results The incisions of 17 patients healed from 14 to 21 days after operation.Sixteen patients who received electron beam radiotherapy had different degrees of local superficial necrosis of scar flap,without affecting the flap survival and wound repair.All patients were followed up for 11 to 30 months.No hyperplasia of keloid was found in all patients.Patients with small scope recurrence of keloid were treated with triamcinolone acetonide.The preserved pathological scars gradually recovered to normal scar tissue in 16 patients who received radiotherapy.Conclusion It is feasible to use super-thin scar flap to repair the wounds in trunk and extremities after medium-sized or large keloid resection.This method will not increase wounds of donor site and has positive clinical significance.

关 键 词：超薄瘢痕瓣 瘢痕疙瘩 手术切除 放射治疗 躯干 四肢 

分 类 号：R622[医药卫生—整形外科]