腋周瘢痕瓣修复腋胸瘢痕粘连

目的 探讨烧伤患者腋胸瘢痕粘连的修复方法。方法 2001年1月～2005年12月，应用腋周瘢痕瓣修复腋胸瘢痕粘连52例（57例次），其中男31例，女21例；年龄1～44岁，中位年龄15岁。采用腋窝后份瘢痕瓣44例次，腋窝前份瘢痕瓣10例次，上臂内侧瘢痕瓣3例次。19例次供瓣区周围皮瓣推进直接缝合，其余38例次行中厚皮片植皮修复。结果 术后54例次瘢痕瓣完全成活，伤口Ⅰ期愈合，3例次瘢痕瓣远端部分坏死，经换药等处理后伤几愈合，且术后获得较好的腋窝形状及肩关节功能。供瓣区直接缝合者伤口均Ⅰ期愈合，中厚皮片移植者皮片均成活。术后均获随访1个月～5年，患者腋窝形态良好，肩关节活动基本不受限，外展平均150°。结论 腋周局部瘢痕瓣是修复腋胸瘢痕粘连、重塑腋窝形状及功能的一种有效途径。

RECONSTRUCTION OF SCAR CONSTRACTURES IN AXILLA AND CHEST WITH LOCAL SCAR SKIN FLAP

OBJECTIVE: To investigate a suitable way to reconstruct sear constractures in the axilla and chest. METHODS: From January 2001 to December 2005, 52 patients (57 episodes) with scar constractures in the axilla and chest were treated, including 31 males and 21 females with an age range of 1-44 years. The deformities of scar constractures in the axilla and chest were reconstructed with posterior part of axillary scar skin flaps (44 epidsodes), anterior part of axillary scar skin flaps (10 episodes) and lateral part of upper arm's scar skin flaps (3 episodes). The flaps were sutured to the surrounding tissues in 19 episodes, the donor sites in other 38 cases were covered with split thickness skin grafts. RESULTS: Fifty-four scar skin flaps survived completely by the first intention except 3 flaps, which margin necrosed and healed with dressing changes. All patients were followed up 1 month to 5 years. All patients gained a good functional recovery and cosmetic appearance after the operation, and the unfolding function of shoulder restored to 1500. CONCLUSION: Axillary local scar skin flap is a good alternative method to reconstruct scar constractures in the axilla and chest.