皮下非对称减张联合真皮埋没成角褥式缝合在婴幼儿面部良性色素性皮损手术治疗中的应用  

Application of subcutaneous asymmetric tension reduction combined with dermal buried angular mattress suture in surgical treatment of benign pigmented facial lesions in infants and preschoolers

作　　者：闫娜[1] 陈婷 耿松梅[3] 李政霄[3] 刘燕[1] 马迎新 谭宣丰 Yan Na;Chen Ting;Geng Songmei;Li Zhengxiao;Liu Yan;Ma Yingxin;Tan Xuanfeng(Department of Dermatology,Hanzhong Central Hospital,Hanzhong 723000,Shaanxi,China;Department of Dermatology,the First Affiliated Hospital of Air Force Medical University,Xi′an 710032,China;Department of Dermatology,the Second Affiliated Hospital of Xi′an Jiaotong University,Xi′an 710004,China)

机构地区：[1]汉中市中心医院皮肤科,汉中723000 [2]空军军医大学第一附属医院皮肤科,西安710032 [3]西安交通大学第二附属医院皮肤科,西安710004

出　　处：《中华皮肤科杂志》2024年第1期54-57,共4页Chinese Journal of Dermatology

摘　　要：目的 探讨皮下非对称减张联合真皮埋没成角褥式缝合在婴幼儿面部良性色素性皮损手术治疗中应用的临床效果.方法 回顾2018年1月至2019年1月于汉中市中心医院及西安交通大学第二附属医院皮肤科就诊的100例面部色素性皮损患儿的临床资料,其中男性59例,女性41例,年龄3个月至5岁,平均15个月.行门诊局麻手术,术前使用镇静药物,根据皮损面积一次或分次切除皮损,先采用皮下非对称缝合方法减少张力,再采用真皮埋没成角褥式缝合切口,术后使用医用硅酮凝胶及减张器半年至1年并随访.结果 100例患儿术后均随访1年以上,4例术后2个月内出现排线反应,线结排出后切口完全愈合;3例术后1周拆线时切口上下两端有小猫耳形成,未予处理,随访1年后猫耳逐渐变平;1例术后4 d出现脂肪液化,拆除内缝线,引流,1周后重新缝合,切口愈合良好;1例术后3 d出现感染,拆除内缝线,予引流和抗感染治疗,待切口红肿完全消退后重新缝合,切口愈合良好;4例术后3~6个月出现瘢痕增生,曲安奈德封闭治疗后较前变平.余患儿切口愈合后均表现为线状细小白线,切口两端凹陷及隆起均变平,无明显五官牵拉及猫耳形成.结论 皮下非对称减张联合真皮埋没成角褥式缝合术在婴幼儿面部精细手术中可有效地进行两次减张,避免切口拉宽及瘢痕增生,长期随访显示可获得良好的远期疗效和美学效果.Objective To investigate the clinical efficacy of subcutaneous asymmetric tension reduction combined with dermal buried angular mattress suture in surgical treatment of benign pigmented facial lesions in infants and preschoolers.Methods Totally,100 infants and preschoolers with pigmented facial lesions were enrolled from the Department of Dermatology,Hanzhong Central Hospital and the Second Affiliated Hospital of Xi′an Jiaotong University from January 2018 to January 2019,and their clinical data were analyzed retrospectively.Among these patients,there were 59 males and 41 females,and their age ranged from 3 months to 5 years,with an average age of 15 months.All patients underwent outpatient surgery under local anesthesia,and sedative drugs were used before operation.The skin lesions were excised once or in stages according to their areas,and incisions were closed by using a subcutaneous asymmetric suture-based tension reduction technique,followed by dermal buried angular mattress sutures.After surgery,medical silicone gels and tension reduction devices were used for 6 months to 1 year,and postoperative follow-up was performed.Results All patients were followed up for more than 1 year after surgery.Four patients showed suture rejection reaction within two months after surgery,and the incisions completely healed after the suture knots were discharged;cat′s ear-shaped scars were formed at the upper and lower ends of the incisions in 3 cases when the sutures were removed 1 week after surgery,no treatment was given,and the cat′s ear-shaped scars gradually became flat after 1 year of follow-up;fat liquefaction occurred in 1 case 4 days after surgery,re-suturing of the incision was done 1 week after the removal of internal sutures and drainage,and the incision healed well;1 case developed infection 3 days after surgery,and then received the removal of internal sutures,drainage,and anti-infection treatment,re-suturing was performed after complete regression of the incision swelling,and the incisions healed well;sca

关 键 词：面部皮肤病 色素沉着异常 痣 婴儿 皮下非对称减张缝合 埋没成角褥式缝合 精细手术 

分 类 号：R726.2[医药卫生—儿科]