背部供皮区修复大面积皮肤缺损

目的探讨应用背部供皮区修复大面积皮肤缺损的优点。方法对Ⅲ°烧伤、巨大体表肿瘤切除、四肢皮肤撕脱伤及其他原因造成的大面积皮肤缺损的40例患者,根据缺损的部位和大小,用鼓式取皮机在患者背部切取相应的中厚皮片,移植修复缺损。结果术后随访患者1年,所有移植皮片均成活。背部供皮区愈合良好,瘢痕增生轻微,不影响外观。结论于背部取皮其供皮面积大、部位隐蔽,且背部真皮层较厚,取皮后愈合快,愈合后患者能自行平卧加压,避免瘢痕增生。是较理想的修复大面积皮肤缺损的手术方法。     

背部供皮区修复大面积皮肤缺损

目的 探讨应用背部供皮区修复大面积皮肤缺损的优点.方法 对Ⅲ°烧伤、巨大体表肿瘤切除、四肢皮肤撕脱伤及其他原因造成的大面积皮肤缺损的40例患者,根据缺损的部位和大小,用鼓式取皮机在患者背部切取相应的中厚皮片,移植修复缺损.结果 术后随访患者1年,所有移植皮片均成活.背部供皮区愈合良好,瘢痕增生轻微,不影响外观.结论 于背部取皮其供皮面积大、部位隐蔽,且背部真皮层较厚,取皮后愈合快,愈合后患者能自行平卧加压,避免瘢痕增生.是较理想的修复大面积皮肤缺损的手术方法.     

背部供皮区在大面积烧伤后期整复中的应用

目的探讨背部供皮区应用于大面积烧伤后期整复中的优势。方法对52例大面积烧伤后期整复患者,采用鼓式取皮机在背部切取中厚皮片,移植修复多处瘢痕切除创面,观察供、植皮区愈合情况。结果52例患者术后随访1～2年,移植皮片均成活,质地柔软、平整光滑,富有弹性,无明显增生性瘢痕,关节区活动自如,功能和外观恢复良好。供皮区愈合良好,无瘢痕增生或增生轻微。结论背部供皮区可多次切取中厚皮片,用于大面积皮肤瘢痕创面的修复,手术效果良好,是大面积烧伤后期整复中的理想供区。     

自体刃厚头皮片移植厚中厚皮片供区以抑制瘢痕增生

目的:探讨应用自体刃厚头皮片移植厚中厚皮片供区以抑制瘢痕增生的可行性及应用效果。方法:烧伤后全身大范围的增生性瘢痕患者24例,行功能部位的增生性瘢痕切除,应用非功能部位的大张厚中厚皮片修复,厚中厚皮片供区应用刃厚头皮片移植修复。结果:24例患者非功能部位厚中厚皮片供区经刃厚头皮片移植后,未见有明显的瘢痕增生。经随访半年至2年11例,2年以上3例,均未见有明显的瘢痕增生。头皮片供区无瘢痕形成,头发生长良好。结论:应用自体刃厚头皮片移植厚中厚皮片供区抑制瘢痕增生是一种可行的方法,值得临床推广。     

异体脱细胞真皮基质与自体皮片复合移植的临床应用

目的:探讨异体脱细胞真皮基质与自体皮片复合移植修复大面积深度烧伤及瘢痕切除后皮肤缺损创面及其愈合后皮肤的外形和功能。方法:应用异体脱细胞真皮基质与自体刃厚皮片组成复合皮移植,以自体刃厚皮片移植作为对照,采用一步移植法治疗切痂后大面积深度烧伤创面及瘢痕切除后皮肤缺损共56例患者60处创面,观察术后皮片的成活情况、外形及功能恢复情况并随访。结果:60处创面全部愈合,移植皮片生长良好,瘢痕增生不明显,未见明显挛缩,皮肤弹性较好。在6～12个月的观察期内,自体刃厚皮片与异体脱细胞真皮基质复合移植后,功能和形态优于单纯自体刃厚皮片移植;随访2年复合移植未发现明显的排异反应。结论:异体脱细胞真皮基质与自体皮片复合移植修复大面积深度烧伤及瘢痕切除后皮肤缺损创面愈合良好,无瘢痕增生,皮肤外观功能满意,无排异反应。     

异体脱细胞真皮基质与自体皮片复合移植的临床应用

目的:探讨异体脱细胞真皮基质与自体皮片复合移植修复大面积深度烧伤及瘢痕切除后皮肤缺损创面及其愈合后皮肤的外形和功能。方法:应用异体脱细胞真皮基质与自体刃厚皮片组成复合皮移植,以自体刃厚皮片移植作为对照,采用一步移植法治疗切痂后大面积深度烧伤创面及瘢痕切除后皮肤缺损共56例患者60处创面,观察术后皮片的成活情况、外形及功能恢复情况并随访。结果:60处创面全部愈合,移植皮片生长良好,瘢痕增生不明显,未见明显挛缩,皮肤弹性较好。在6～12个月的观察期内,自体刃厚皮片与异体脱细胞真皮基质复合移植后,功能和形态优于单纯自体刃厚皮片移植;随访2年复合移植未发现明显的排异反应。结论:异体脱细胞真皮基质与自体皮片复合移植修复大面积深度烧伤及瘢痕切除后皮肤缺损创面愈合良好,无瘢痕增生,皮肤外观功能满意,无排异反应。     

以头皮为供区在创面修复中的应用

目的 探讨以头皮为供区修复创面的疗效。方法 以头皮为供区治疗17例因创伤导致躯干和四肢皮肤坏死或缺损创面的患者。皮片厚度0.3～0.4 mm。结果 12例移植皮片全部成活，5例部分区域成点状坏死，经过换药后爬行愈合。患者均获得随访，时间6～12个月。皮片成活后早期表面较粗糙，1～3个月出现瘢痕挛缩，术后6～12个月皮片慢慢舒展变平，外观良好。头皮供区术后10～14 d愈合，初始愈合时可见取皮痕迹明显，呈淡红色，毛发生长如常；术后3～6个月后均可恢复平坦，无瘢痕增生。结论 以头皮为供区是创面修复的良好选择，供区愈合快，一般不留瘢痕，可避免供区永久损伤。     

组织工程化表皮膜片移植中厚皮供区预防瘢痕增生30例

整形、烧伤外科修复面颈部及功能部位皮肤缺损，广泛使用方法是切取大张中厚皮片移植。中厚皮供区常规治疗方法愈合后遗留增生性癞痕。我科自2003年以来采用组织工程化表皮膜片移植中厚皮供区创面30例，该法在促进创面愈合及抑制瘢痕增生方面取得了显著疗效，报道如下。     

皮耐克在大面积烧伤患者关节部位瘢痕挛缩修复中的应用

目的:探讨人工真皮皮耐克在大面积烧伤患者关节部位瘢痕挛缩修复中的应用效果。方法:在大面积烧伤患者关节部位瘢痕挛缩的修复应用中,一期行瘢痕切除联合皮耐克覆盖术,2~3周后行二期自体刃厚皮片移植术,观察手术效果。结果:移植皮片全部成活,修复关节功能良好,外观满意。远期随访供皮区仅轻度色素沉着,无瘢痕增生。结论:皮耐克联合自体刃厚皮移植在大面积烧伤患者关节部位瘢痕挛缩的修复中具有良好的应用价值,值得临床推广。     

应用自体皮片移植联合VSD负压吸引技术治疗阴茎大面积皮肤缺损

目的探讨采用自体皮片移植联合VSD负压吸引技术治疗阴茎大面积皮肤缺损的临床疗效。方法对阴茎缺损创面彻底清创,并清除坏死组织及异物等。于大腿内侧皮肤切取符合缺损创面大小的自体皮片;在阴茎充分伸展状态下将皮片移植于缺损区。然后将两块负压吸引海绵敷料对称固定于阴茎表面,使用生物半透膜封闭敷料,连接中心负压吸引装置,以负压为-120 mm Hg持续吸引,术后10 d拆除VSD装置,观察植皮区皮片成活的情况。结果本组共11例患者,术后移植皮片均一期成活,无血肿、感染及瘢痕增生等并发症。7例获随访6～48个月,阴茎皮肤质地、柔韧性及色泽均较好,阴茎外观及功能恢复正常。结论采用自体皮片移植联合VSD负压吸引技术治疗阴茎大面积皮肤缺损,能有效解决皮下积血、积液以及因阴茎勃起而致包扎困难等问题,有利于移植皮片的成活,且术后瘢痕不明显,达到了保持完整的阴茎结构及功能效果。     

大张次全厚皮片在功能部位软组织缺损修复术中的应用

目的:探讨大张次全厚皮片修复功能部位软组织缺损的临床效果。方法:选择2014年7月-2017年7月安阳市人民医院烧伤整形科收治的54例创伤需植皮修复者,采用大张次全厚皮修复皮肤缺损,观察其修复治疗效果,调查患者满意度。结果:54例患者创面一期愈合50例,皮片完全成活;4例患者皮片出现点片状坏死,经换药二期愈合,成活皮片色泽接近正常皮肤。供区愈合良好,无明显瘢痕。患者均对治疗效果满意。结论:大张次全厚皮片具有类似全厚皮片的优点,获取容易,符合医学、美学要求,是修复功能部位皮肤缺损的一种重要方法。     

VSD结合游离植皮治疗儿童下肢大面积皮肤缺损

目的 探讨负压封闭引流(Vacuum sealing drainage,VSD)装置结合头皮游离植皮,治疗儿童下肢大面积皮肤缺损的临床效果.方法 对18例下肢大面积皮肤缺损的患儿,一期先行清创手术,然后使用VSD持续负压吸引创面,待创面新鲜无感染、肉芽新鲜时,行二期头部刃厚皮片或中厚皮片移植覆盖创面.结果 15例患者移植皮片完全成活,3例患者去除VSD敷料后,边缘少许坏死,积极换药后愈合.本组患者术后随访3～12个月,无慢性感染、溃疡和窦道存在,效果满意.结论 应用VSD技术可以有效地协助组织瓣修复复杂或慢性创面,值得临床推广和进一步深入研究.     

筛网状全厚皮片移植联合封闭负压引流治疗四肢皮肤缺损

目的探讨全厚皮片延期移植联合封闭负压引流(VSD)治疗四肢皮肤缺损的临床效果。方法对38例外伤性四肢皮肤缺损患者行清创+VSD术,待缺损区创面肉芽新鲜时,行筛网状全厚皮片移植并用VSD敷料覆盖,持续负压吸引,3～5 d后去除VSD敷料。结果 38例均获随访,时间3个月～2年。35例皮片一次全部成活,3例皮片边缘少许坏死伴渗液,经换药治愈;植皮区外观满意,弹性好,无瘢痕挛缩;取皮区留有线形瘢痕,无瘢痕增生、疼痛等。结论筛网状全厚皮片联合VSD延期植皮修复四肢皮肤缺损成活率高,外观满意,疗效好。     

Skin perforators of back region: anatomical study and clinical applications

BACKGROUND: Despite widespread studies that have been commonly performed recently on skin perforators and perforator flaps of various regions of the body, investigations on the back region of the body are still insufficient. This study investigates the anatomical characteristics and clinical applications of perforating vessels in the back region. MATERIALS AND METHODS: The skin on the back region between the right and left, 7th to 11th thoracic vertebrae of 10 fresh cadavers were raised as flaps. Perforating vessels perfusing the skin with pedicle diameters of over 1 mm were included in the study. The anatomical localization, diameter, pedicle size, and the supplying vessels of these pedicles were determined. Utilizing this information, the defects of 8 patients with large meningomyeloceles included in the study were closed with prepared intercostal artery perforating flap. RESULTS: Perforators of the back region were seen to originate from the posterior intercostal vessels. There were a higher number of perforators on the right side of the body. The most commonly observed perforators were the 7th and 9th posterior intercostal perforators, and their diameters were larger. All flaps were viable following perforator flap closure for defects in 8 patients with large meningomyelocele included in the clinical study. No problems were encountered in the postoperative 3-month follow-up of cases. CONCLUSION: Owing to the low donor area morbidity and wide motion capabilities, the perforator flap is a new choice of flap for the back region. Perforator pedicle flaps supplied by the posterior intercostal vessels may be safely used in congenital tissue defects, such as meningomyelocele, tumors, and traumatic defects.     

结构化皮肤护理应用于烧伤瘢痕修复患者的美学效果

目的 探究在烧伤瘢痕修复患者中使用结构化皮肤护理的应用效果。方法 选取2022年 2月-2023年2月我院收治的60例烧伤瘢痕修复患者作为研究对象，按随机数字表法分为对照组及 研究组，各30例。对照组采用常规护理，研究组采用结构化皮肤护理，比较两组手术效果、疼痛 程度以及焦虑抑郁评分。结果 研究组术后2周皮下淤血率与植皮成活率优于对照组，术后1个月移 植皮肤挛缩程度低于对照组（P＜0.05）；研究组护理后疼痛评分低于对照组（P＜0.05）；研究组护理 后焦虑与抑郁情绪评分低于对照组（P＜0.05）。结论 结构化皮肤护理应用于烧伤瘢痕修复患者中，能够 缓解患者疼痛，提高植皮成活率，减少患者焦虑抑郁情绪，值得临床应用。     

异体脱细胞真皮在软组织缺损修复中的应用

目的:评估应用异体脱细胞真皮(allo-ADM)修复体表软组织缺损的临床效果。方法:12例面部凹陷畸形,用allo-ADM填充修复;23例功能部位瘢痕挛缩畸形和5例胸部瘢痕疙瘩合并溃疡,松解、切除瘢痕后用allo-ADM与自体刃厚皮复合移植修复。结果:12例面部凹陷畸形填充术后Ⅰ期愈合,随访6个月~1年,除2例因填充量不足而再次手术外,均未见明显排异、吸收等并发症,局部柔软,外形良好。28例复合皮移植术后,除1例因感染致部分坏死(40%)外,其余成活率在90%以上;随访1年,外观与功能均近似自体中厚或全厚皮移植效果。结论:allo-ADM是填充、修复体表软组织缺损较理想的材料,亦为瘢痕疙瘩的治疗提供了新的方法。     

Forehead Donor Site Full-Thickness Skin Graft

BACKGROUND: Full-thickness skin grafts (FTSGs) are useful for reconstructing nasal defects. Traditional reported donor sites include the preauricular, postauricular, supraclavicular, clavicular, conchal bowl, melolabial fold, and upper eyelid skin. Selection of the "best" donor site is based on the "best" tissue match and ability to camouflage the donor scar. OBJECTIVE: The purpose was to report our experience with FTSGs harvested from the forehead for reconstruction of nasal defects following Mohs' surgery. METHODS: A retrospective query of the Mohs' surgery database was performed to identify nasal defects repaired with a FTSG harvested from the forehead skin. The research record contained the patient age and gender, defect size, and cosmetic and functional outcomes interpreted by the patient and surgeon. RESULTS: FTSGs from forehead skin were used to repair the nasal defects in three patients. The functional and cosmetic outcome of all three cases was deemed excellent by the patient and surgeon. Donor site scars were well concealed within preexisting rhytids. CONCLUSION: FTSGs harvested from the forehead, although limited in practical utility, may offer an optimal FTSG match for limited select defects while also providing an easily camouflaged donor site scar within a forehead rhytid.     

Adjacent-Tissue Skin Grafts for Reconstruction

BACKGROUND: Large defects not easily repaired with local flaps and defects near anatomic free margins or crossing anatomic units present unique challenges for reconstruction. Cosmetic results of full-thickness skin grafts may appear unsatisfactory owing to differences in color, texture, and thickness between donor and recipient sites. OBJECTIVE: The objective was to describe a skin-graft reconstructive method that better approximates skin characteristics between donor and recipient sites while following other criteria to improve the final aesthetic and functional result. METHODS: Careful evaluation of the tissue surrounding a surgical defect determines tissue laxity available for skin grafting and whether the defect crosses anatomic units or may distort anatomic free margins or landmarks. Through partial closure of the large surgical defect, preferably within cosmetic units, a tricone is created large enough to graft the remaining wound. RESULTS: Creating smaller wounds within cosmetic units or subunits, there is less chance of distortion of nearby anatomic free margins or landmarks. Skin grafting is accomplished with tissue of similar color, texture, and thickness CONCLUSION: Adjacent-tissue skin grafts provide a suitable reconstruction option for surgical defects too large for simpler repair or defects crossing cosmetic units or near free margins. This procedure permits repair with a full-thickness skin graft of more similar skin characteristics to the recipient site.