应用脐旁皮瓣修复会阴部烧伤瘢痕挛缩畸形临床效果观察

目的探讨应用脐旁皮瓣修复会阴部烧伤瘢痕畸形的临床效果。方法 2003年3月至2011年1月我院整形外科收治会阴部烧伤瘢痕畸形患者32例。术中完全松解及切除会阴部瘢痕组织,使尿道口、阴道口及肛门恢复到解剖位置。肛门严重狭窄者,需彻底切除肛门周围及肛管的瘢痕组织,完全解除狭窄,使肛门口充分开放,将形成的脐旁皮瓣行明道转移至会阴部。在皮瓣中间对应尿道外口及肛门位置切开形成尿道及肛门外口,肛门外口与直肠黏膜缝合,将皮瓣缝合于会阴创面。结果 32例患者中3例出现皮瓣远端发绀,经检查发现2例皮瓣下积血,1例因缝合张力过大引起。清除血肿及拆除部分缝线后皮瓣远端循环得到改善,皮瓣完全存活,经延迟拆除缝线后伤口愈合。1例出现皮瓣感染,导致远端部分坏死,后通过植皮进行创面修复。术后随访0.5～1年,术后皮肤质地、会阴外形功能及生殖器位置均良好;双髋活动度除2例因缺乏功能锻炼及皮瓣皮片后期挛缩恢复不理想外,其余双髋活动度良好。结论脐旁皮瓣不受会阴瘢痕限制,组织相似度好,血管恒定,抗感染能力强,是修复会阴部瘢痕畸形的理想皮瓣。

Clinical effect of paraumbilical flap in repair of burn scar contracture in perineal region

Objective To investigate the clinical effect in repair of burn scar contracture in perineal region. Methods From March 2003 to January 2011,23 patients with burn scar contracture in perineal region were treated. We completely released and removed scar tissues in perineal region during operation to make urethral orifice, vaginal orifice and anus return to anatomical location. For patients with severe narrowing in anus, we should completely remove the scar tissues around anus and anal canal, completely relieve stenosis in anus to fully open it, and directly transfer the paraumbilical flap to perineal region. Then we cut open the middle of flap to form the new urethral orifice and anal orifice, sewed the anal orifice and rectal mucous membrane together, and sewed up the flap in the wound surface of perineum. Results Among the 32 cases, there were 3 cases of cyanosis in distal flap ,2 cases of hemorrhage under the flap （ one caused by excessive tension）. After removing hematoma and part of the suture, circulation in distal flap was improved. The flap completely survived and healed after delayed removal of stitches. Infection occurred in 1 case,which resulted in partial necrosis in distal flap. The wound surface was repaired by dermatoplasty. All patients were followed up from six months to a year. Skin texture, perineal appearance and function, and genital position were good after operation. Two cases were not completely recovered for lack of exercise and contracture of skin graft. The activity of both hips was good in rest of the patients. Conclusion Paraumbilical flap, free from the influence of perineal scar, has the advantages of good compatibility in tissues, good constancy in vascular and strong resistance to infection,which is the ideal flap in repair of perineal scar deformity.