胸部瘢痕治疗中应用内窥镜辅助扩张器置入的疗效观察

背景:皮肤扩张器被认为是整形外科发展史上的里程碑性的成果,因为扩张产生的皮肤在色泽、质地、结构等方面与受区相匹配,而且避免了传统手术供区的畸形,具有传统修复方法无可比拟的优点。目的:探讨借助内窥镜行扩张器置入治疗胸部瘢痕的方法。设计:非随机对照的研究。地点和对象:2002-12/2004-01本院收治患者16例,男3例,女13例;年龄13～37岁。烧伤后瘢痕14例,黑毛痣2例。病灶均位于胸部。干预:采用远位、锯齿状小切口,内窥镜“直视”下分离腔隙,术中即刻注水,注水量为扩张器容量的1/5～1/2,术后第2天开始按常规注水。主要观察指标:观察术后第1,2天引流量,皮肤扩张所需时间及并发症发生情况。结果:术后第1,2天引流量18～30mL,较常规明显减少。皮肤扩张所需时间1～1.5个月,提前两三周。无血肿、切口裂开、扩张器外露等并发症发生。术后效果满意。结论:内窥镜辅助胸部扩张器置入能减少组织创伤,缩短皮肤扩张所需时间,减少并发症发生。

Curative effect of endoscopes-assisted expander placement for scar treatment on breast

BACKGROUND: Skin expander is believed to be a milestone in the development of plastic surgery, because the skin derived from expansion matches the recipient in color, texture and structure so well. It also avoids deformity in donor site that may be induced by traditional surgery. Thus, it has an overwhelming advantage over traditional methods.OBJECTIVE: To investigate a method of tissue expander placement for scar treatment on breast with endoscopes.DESIGN: A nonrandomized controlled trial was conducted. SETTING and PARTICIPANTS: From December 2002 to January 2004,16 patients were enrolled in this study, 3 males and 13 females, aged 13-37 years, among whom 14 were scar secondary to burn and 2 were giant congenital nevus. All the lesions were located on breast.INTERVENTIONS: Through distal and serrate incision, endoscope was used to construct the pocket in which the expander can be positioned at a direct sight. Injection was performed during operation with a volume of 1/5 to 1/2of the expander capacity, and routine injection was carried out since the second day postoperatively.MAIN OUTCOME MEASURES: Drainage volume on the first and second day after surgery and time required for skin distention as well as the incidence of complication were observed.RESULTS: The drainage volume on the first and second day after surgery ranged from 18 to 30 mL, significantly less than normal value. The time required for skin distention was 1 - 1.5 months, which was 2 - 3 weeks shortened. Complications including haematoma, disruption of wound and exposure of expander were not found. The efficacy of the surgery was satis factory.CONCLUSION: Endoscopes assisted, expander placement for scar treatment on breast can alleviate injury to tissue, decrease the time required for skin distention and reduce the incidence of complications.