扩张皮瓣整复大面积烧伤后面颈部瘢痕挛缩畸形的临床效果  

Clinical effects of expanded flaps in reconstructing scar contracture deformities in the face and neck after extensive burns

作　　者：张伟 张卫东 陈斓 栾夏刚 杨飞 李泽 刘峰 王德运 Zhang Wei;Zhang Weidong;Chen Lan;Luan Xiagang;Yang Fei;Li Ze;Liu Feng;Wang Deyun(Department of Burns,Tongren Hospital of Wuhan University&Wuhan Third Hospital,Wuhan 430060,China)

机构地区：[1]武汉大学同仁医院暨武汉市第三医院烧伤科,武汉430060

出　　处：《中华烧伤与创面修复杂志》2023年第9期826-834,共9页Chinese Journal of Burns And Wounds

基　　金：湖北省卫生健康科研基金(WJ2019H433);武汉市临床医学科研项目(WX17A03,WX11A04);武汉市医学科研项目(WG19B02)。

摘　　要：目的探讨扩张皮瓣整复大面积烧伤后面颈部瘢痕挛缩畸形的临床效果。方法采用回顾性观察性研究方法。2016年5月—2022年9月,武汉大学同仁医院暨武汉市第三医院收治17例大面积烧伤后面颈部瘢痕挛缩畸形患者,其中男13例、女4例,年龄23~55岁,颈部挛缩程度Ⅱ度者3例、Ⅲ度者14例,12例患者合并面部瘢痕挛缩畸形。Ⅰ期于面、胸、肩、腹部等处置入34个额定容量为100~600 mL的长方形皮肤软组织扩张器(以下简称扩张器)注射生理盐水扩张。Ⅱ期切除瘢痕组织、松解挛缩,纠正畸形,局部转移2个扩张面部皮瓣、带蒂转移17个扩张皮瓣、游离移植15个扩张皮瓣修复松解后继发创面(对7个皮瓣行动脉增压),并使用吲哚菁绿荧光显影技术评估移植时皮瓣动脉血流灌注和静脉回流状况。除2个面部皮瓣外的32个皮瓣切取面积为10 cm×8 cm~36 cm×16 cm,将31个皮瓣供区创面直接缝合封闭,1个皮瓣供区创面采用自体刃厚头皮移植修复。观察并记录扩张器的埋置部位皮肤状态、扩张时间、注射生理盐水总量,皮肤软组织扩张术并发症发生情况,Ⅱ期术后皮瓣成活情况。随访患者面颈部远期整复效果和皮瓣供区恢复情况。末次随访时,采用利克特5级量表评价患者的疗效满意度。结果17例患者的34个扩张器埋置部位中,22个部位为深Ⅱ度烧伤后浅表瘢痕皮肤,8个部位为多次供皮后浅表瘢痕皮肤,4个部位为正常皮肤。经4~15个月的扩张,扩张器注射生理盐水总量为238~2000 mL,扩张区域无并发症发生。Ⅱ期术后,2个带蒂移植皮瓣蒂部远端部分坏死,坏死创面分别经皮瓣修整和对侧扩张胸三角皮瓣游离移植后愈合,其余皮瓣均完全成活。随访6~18个月,2个扩张脐旁皮瓣和1个扩张腹股沟皮瓣较臃肿,行修薄术后臃肿改善,其余皮瓣外观、质地良好;所有皮瓣供区均恢复良好。末次随访时,所有患者面颈部瘢Objective To investigate the clinical effects of expanded flaps in reconstructing scar contracture deformities in the face and neck after extensive burns.Methods A retrospective observational study was conducted.From May 2016 to September 2022,17 patients with scar contracture deformities in the face and neck after extensive burns were admitted to Tongren Hospital of Wuhan University&Wuhan Third Hospital,including 13 males and 4 females,aged 23 to 55 years,with 3 patients having degreeⅡcervical contracture,14 patients having degreeⅢcervical contracture,and 12 patients having facial scar contracture deformity.In the first stage,34 rectangular skin and soft tissue expanders(hereinafter referred to as expanders)with rated capacity of 100-600 mL were inserted into the face,chest,shoulder,and abdomen,and then the normal saline was injected for expansion.In the second stage,the scar tissue was removed and the contracture was released to correct the deformity.Two expanded facial flaps were transplanted in local fashion,17 expanded flaps were transplanted in pedicled fashion,and 15 expanded flaps were freely transplanted to repair the secondary wounds after release,with artery pressurization was performed in 7 flaps.Indocyanine green fluorescence imaging was used to evaluate the arterial blood perfusion and venous return of the flaps during transplantation.The incision area of 32 flaps except 2 facial flaps was 10 cm×8 cm-36 cm×16 cm.The wounds of 31 flap donor sites were closed by direct suture,and the wound of 1 flap donor site was repaired by autologous split-thickness scalp transplantation.The skin condition of inserted place,expansion time,and total amount of normal saline injection of expanders,complications of skin and soft tissue expansion surgery,and survival of flap after the second stage surgery were observed and recorded.The long-term face and neck reconstruction effect and recovery of flap donor area were followed up.At the last follow-up,the 5-level Likert scale was used to evaluate the efficacy satis

关 键 词：烧伤 瘢痕 颈 挛缩 扩张术 穿支皮瓣 显微外科手术 

分 类 号：R622[医药卫生—整形外科]