小容量皮肤扩张术在面部瘢痕美容修复中的应用

目的 探讨小容量皮肤扩张用于面部瘢痕美容修复的临床应用价值。方法 先用10～100ml容量的皮肤扩张器置入瘢痕旁的皮下，注水壶内置或外置，定期注水扩张，扩张期4～8周，Ⅱ期手术取出扩张器，切除瘢痕，利用扩张皮瓣修复缺损。结果 临床应用32例，发生扩张器感染和扩张器外露各1例，但经及时处理后，2例患者最终未影响手术效果。随访半年至3年，皮瓣平整，外观色泽、质地均佳，切口瘢痕不明显，疗效满意。结论 小容量皮肤扩张适用于面部瘢痕畸形的美容修复，具有良好的美容效果。     

皮肤软组织扩张治疗小儿面颈部瘢痕

目的总结皮肤软组织扩张器在小儿面颈部烧伤后瘢痕修复中的“V”型切口应用技巧，评价扩张术的应用效果。方法对32例患儿应用97枚扩张器行扩张皮瓣修复治疗面颈部烧伤后瘢痕。在瘢痕区内设计“V”型切口，切开皮肤全层后直视下分离出与扩张器大小相宜的皮下腔隙，置入扩张器，容量为80－300ml，注射壶外置。每2、3天注水一次，扩张时间约60d，超量扩张满意后行Ⅱ期手术修复面颈部瘢痕畸形。结果术后发生血肿2例，皮瓣坏死1例，切口裂开1例。随访6～12个月，32例患儿经Ⅱ期手术修复后取得良好的功能和外观效果，皮瓣质地、色泽理想。结论应用皮肤软组织扩张期治疗小儿面颈部烧伤瘢痕，节约皮源，减少供皮区瘢痕，可以达到良好的功能、外观修复效果，是首选治疗方法。     

皮肤软组织扩张术在烧伤整形外科中的应用

目的:观察应用皮肤软组织扩张术修复烧伤瘢痕、色素痣、秃发等病损的效果。方法:应用皮肤软组织扩张术将扩张器植入头面部、颈部、四肢等处,且在与病损相邻的正常皮肤下扩张后修复病损186例,术中采用的扩张器大小及数量依病损面积而定。按每修复1cm×1cm缺损需扩张器容量5ml计算,扩张后的皮瓣设计成滑行推进皮瓣、旋转皮瓣、交错皮瓣或远距离带蒂皮瓣等。结果:本组186例,其中15例皮瓣尖端部分血运障碍,其余171例外形良好,效果满意。结论:扩张术是烧伤整形外科中修复创面的较好的方法。     

面部扩张皮瓣修复眶下区及颊部皮肤缺损

眶下区及颊部是血管瘤、斑痣的好发部位 ,亦可因外伤或烧伤后遗留瘢痕 ,常难以妥善治疗。该部位位于面部中心 ,对外观的影响很大 ,即使是全厚皮片也存在颜色差异 ,受区周围缝线瘢痕 ,如病变累及下睑 ,还可能因皮片的后期挛缩引起下睑外翻。我们对该部位一定面积的缺损采取面部扩张皮瓣或面部、耳后联合扩张皮瓣 ,一次修复缺损 10例 ,取得满意效果。1　手术方法一期手术沿病变皮肤的边缘于面部皮下层埋置 10 0～15 0ｍｌ大小的扩张器 ,或联合于耳后埋置 5 0ｍｌ大小的另一扩张器 ,注射壶外置或内置 ,扩张过程约 2个月。二期手术一般在扩张皮…     

扩张后胸三角皮瓣修复面颈部较大面积皮肤软组织缺损

目的：探讨应用扩张后胸三角皮瓣修复面颈部较大面积皮肤软组织缺损的效果。方法：自2006年以来,对我科收治的20例患者,其中17例面部瘢痕、2例颈部瘢痕和1例面部黑毛痣,在胸三角区置入300～400ml柱形扩张器,经3～5个月注水,注水后容量为500～1000ml获得足够的皮肤后,切除面颈部瘢痕,创面应用扩张后胸三角皮瓣转移修复,1月后断蒂,利用蒂部皮瓣修复剩余瘢痕切除后的创面。结果：共置入22个扩张器,除1例扩张器外露,1例出现感染终止扩张,18例（20个）扩张器顺利扩张。皮瓣转移后2例皮瓣远端发生少量坏死,经换药或植皮后创面愈合,其余16例（18个扩张器）转移的皮瓣全部成活,皮瓣色泽厚度质地接近正常部位,患者和家属均满意,取得了很好的修复效果。结论：对于面颈部瘢痕或体表病变手术后的较大面积皮肤软组织缺损,应用扩张后胸三角皮瓣修复是一种很好的方法。     

应用扩张皮瓣修复下眼睑外翻

目的探讨利用皮肤软组织扩张技术,修复各种原因所致下眼睑外翻。方法利用皮肤扩张器对40例各种原因所致下眼睑外翻患者行后期整复治疗,扩张器容量最小30ml,最大150ml;扩张时间2～3个月,扩张满意后面部皮肤以局部皮瓣旋转或推进整复下眼睑外翻。结果40例患者疗效基本满意,随访2年未见复发,其中2例因皮瓣局部臃肿行修薄术,扩张皮瓣色泽及质地均接近正常皮肤。结论在下眼睑外翻的后期整复中,合理应用皮肤软组织扩张技术可以取得较好的治疗效果,供区切口隐蔽,而且不易复发。     

皮肤扩张术在面部皮肤病损修复中的应用

目的:总结应用皮肤扩张术修复面部皮肤病损的临床经验。方法:Ⅰ期手术选用50～400ml容量的扩张器埋植于面部病损邻近皮肤正常区域的皮下层,注水扩张1～4个月;Ⅱ期切除面部病损,运用扩张皮瓣修复皮肤缺损。结果:23例中,21例面部病损切除后利用扩张皮肤形成局部皮瓣一次完成修复,修复后的皮肤质地和色泽与受区接近,外形满意。一次修复缺损创面最大者约8cm×11cm。1例于Ⅰ期手术后53天扩张器外露,提前取出扩张器形成局部皮瓣加植皮修复,效果良好;1例为较大面积的面部扁平瘢痕,第一次扩张后仍残留1/4瘢痕,经二次扩张遂完全切除瘢痕并修复。结论:运用皮肤扩张术修复面部病损切除后的皮肤缺损是一种较为理想的修复方法,在某些特殊情况下,可能还需要辅助植皮或应用连续扩张法完成修复。     

扩张器在烧伤后瘢痕修复中的应用

目的探讨扩张器在烧伤后瘢痕修复中的临床应用效果。方法2000年5月~2005年10月,收治烧伤瘢痕患者20例。男13例,女7例;年龄8~32岁。瘢痕位于头面部5例,颈部5例,胸部3例,上肢3例,下肢4例;范围7cm×5cm~21cm×10cm。一期手术植入容量200~400ml的扩张器1~4枚;二期手术切取扩张皮瓣6cm×5cm~10cm×8cm或全厚皮片13cm×10cm进行修复。供区直接缝合。结果4例出现并发症,其中2例扩张器注水4周后局部皮肤坏死,及时行扩张器取出,瘢痕切除,扩张皮瓣修复;2例皮瓣远端坏死,经换药后愈合。其余皮瓣及全厚皮片均成活。皮瓣伤口及供区均Ⅰ期愈合。12例获随访6个月~3年,皮瓣颜色、质地均佳,外观改善满意。结论烧伤后大面积瘢痕应用扩张皮瓣修复效果良好。     

应用多个扩张器联合超量皮肤扩张术治疗先天性巨痣

目的:探讨应用多个扩张器联合扩张皮肤软组织,并延长扩张时间、增加扩张量治疗先天性巨痣的临床疗效。方法:应用皮肤软组织扩张术修复躯干部巨痣9例,手术分两期进行。一期手术:在巨痣周围设计扩张器大小、形状及置入部位,扩张器容量为200～1000ml,扩张时间为3～6个月,扩张器结束时液体量为额度容量的2～5倍;二期手术:取出扩张器,切除巨痣,扩张皮瓣转移修复皮肤缺损。结果:扩张过程无1例出现扩张器因超量扩张出现破裂、渗漏,无出现血肿、感染、扩张器外露或注射壶渗漏等并发症。随访时间6个月到5年,患者术后的皮瓣颜色、质地佳,外观满意。结论:多个扩张器联合应用并延长扩张时间,增加注水量,可以产生更多的额外皮肤,修复躯干部先天性巨痣效果良好。     

应用扩张后皮瓣修复颏部瘢痕

目的探讨应用扩张后皮瓣修复颏部瘢痕的美容效果。方法单纯颏部瘢痕或伴小面积面部瘢痕者,采用颏部、颌底、面部皮肤扩张,扩张器置入时,不要超过颌颈角;否则,扩张器只是将颌颈角填平,不能充分有效扩张皮肤。对于面颊、颏、颈部瘢痕的修复,局部无可供扩张的正常皮肤时,则采用胸三角皮瓣预扩张,扩张充分后带蒂转移修复面部瘢痕,3周后断蒂修复颏、颈部瘢痕。结果26例应用局部及远位扩张后皮瓣修复颏部瘢痕,皮瓣成活良好,术后效果满意。结论应用扩张后的局部或远位皮瓣修复颏部瘢痕,是目前较好的治疗方法。     

Experience of reverse medial arm flaps in the reconstruction of burned elbow scar contractures

There are many methods to correct scar contractures in the elbow region after burn injury, including Z-plasty, Y-V or rectangular flaps, local or distant fasciocutaneous flaps, muscle or myocutaneous flaps, free flaps, tissue expanders and non-surgical orthotics. Among these, the reverse medial arm island flap, based on the recurrent ulnar artery, has proved to be a convenient local fasciocutaneous flap for elbow scar reconstruction. In the past 2 years, 12 reverse medial arm flaps were used in 11 patients. The results are satisfactory. Two complications, one partial flap necrosis, another ulnar nerve compression, were noted. Our clinical experience with this flap encourages us to use it for burn elbow reconstruction in the future. The advantages and disadvantages are discussed.     

Medpor支架在耳廓再造和修复中的应用

目的：探讨Medpor（多孔高密度聚乙烯）支架在耳廓再造和畸形修复中的临床应用价值。方法：先天性小耳畸形和外伤后耳廓部分缺损的病例,采用带血管蒂的颞顶筋膜瓣覆盖Medpor支架,外用皮片移植,一期完成手术;烧伤后耳廓畸形的病例,采用扩张后的头皮瘢痕颞筋膜瓣带血管蒂转移,包裹Medpor支架二期完成修复。结果：共完成23例,前期5例有3例出现支架外露。后期18例手术效果满意,轮廓显现良好,无一例出现支架外露等其它严重并发症。结论：在耳廓再造和畸形修复中应用Medpor支架在临床上是一个可供选择的方法,但要强调各步骤的无张力原则和手术操作方法的相关细节,远期效果尚有待观察。     

皮肤软组织扩张术在面颈部瘢痕修复中的应用

目的：通过对临床资料的回顾,总结皮肤软组织扩张术在面部瘢痕修复中的应用经验及教训。方法：系统回顾自2001年以来54例面颈部瘢痕应用皮肤软组织扩张术治疗的病例,通过对术前设计、扩张器置入技巧、皮瓣应用、修复效果和并发症等资料的总结。探讨颜面部扩张术治疗的经验和教训。结果：临床应用54例,发生血肿2例,感染和切口外露各1例,所有并发症经及时对症处理后未影响手术效果。随访6—36个月,48例患者满意,6例患者主诉切口瘢痕增生明显,需进行二期瘢痕整形术。结论：应用扩张器修复面颈部瘢痕,虽然可以获得良好的效果,但对并发症的预防不可忽视。     

Tissue expansion. Three years' experience at Groote Schuur Hospital

Tissue expansion for breast reconstruction and for improvement of large unsightly scars, not possible with standard local flaps, is a well-tried, effective method. Fifty-nine tissue expanders have been used in 46 patients at Groote Schuur Hospital since August 1982 for both breast reconstruction and scar revision. Expanders were placed in surgically dissected pockets and filling was performed on an outpatient basis. At a second operation the filled expanders were removed and the definitive operation performed. Complications encountered included deflation, exposure, infection, seroma and skin necrosis. Final results in most patients have been satisfactory. Tissue expansion has a wide application in reconstruction and has potential for even greater use in the future.     

头皮扩张术治疗瘢痕性秃发及并发症的防治

目的 总结头皮扩张术治疗瘢痕性秃发并发症发生串及预防处理方法。方法 1995年1月～2005年6月，共收治瘢痕性秃发患者57例，男25例，女32例；年龄5～55岁。致伤原因：烧伤33例，创伤14例，头部手术后残留瘢痕性秃发8例，其它原因2例。病程6个月～15年。共安置扩张器89枚，回顾分析时按年龄分组，进行头皮扩张术治疗瘢痕性秃发的并发症发牛情况及预防处理方法的对比。结果 术后均获随访3～12个月，平均6个月，其中81枚扩张器置入区创面愈合好，头发生长良好，8枚扩张器置入区发生并发症，其中扩张器外露、感染各2例，血肿、扩张器破裂、皮瓣尖端部分坏死和内置注射壶区瘢痕皮肤坏死各1例。5～10岁年龄组与〉50岁年龄组并发症发生率较其他年龄组高（P〈0.05）。同时置入2枚扩张器较1枚扩张器并发症发生率高（P〈0.05）。其他年龄组及不同扩张器种类，并发症的发生率无统计学意义。并发症通过积极有效的处理，取得满意效果。结论 头皮扩张术治疗搬痕性秃发的并发症是能有效预防的，早期发现并积极处理并发症仍可获得较好疗效。     

多个扩张器联合扩张修复大面积头皮瘢痕性秃发

目的:探讨多个扩张器联合扩张修复大面积头皮瘢痕性秃发的效果。方法:2003年5月~2013年5月间,应用2~4个扩张器联合扩张的方法修复缺损面积为50~350cm2的头皮瘢痕性秃。手术分两期:Ⅰ期根据秃发面积的大小及部位,选择适当大小、形状及数量的扩张器,并在瘢痕周围置入扩张器注水扩张;Ⅱ期根据瘢痕切除术后的缺损情况进行滑行推进或旋转皮瓣修复。结果:80例头皮瘢痕性秃发,74例取得良好效果;3例秃发面积过大,一次扩张未能完全修复,经二次扩张修复后效果良好;1例出现切口感染而取出扩张器;2例出现Ⅱ期术后头皮血肿,经处理后愈合良好。随访5个月~5年,头皮头发生长良好,缝线处无明显瘢痕增生,头部外观有明显改善,患者对手术效果均比较满意。结论:应用多个扩张器联合扩张修复大面积头皮瘢痕性秃发,可以彻底切除瘢痕,使秃发部位有毛发覆盖,头部整体外观得到明显改善,是修复大面积瘢痕性秃发较为理想的一种方法。     

Advances in burn scar reconstruction: the use of tissue expansion

The use of tissue expansion to facilitate burn scar reconstruction is described. Twelve patients underwent burn scar reconstruction using a total of 42 expanders. Expansion was carried out at two- to three-day intervals, usually commencing as early as two to three days following insertion of the expander. In 5 of the 12 patients, previously scarred skin was expanded to facilitate excision of areas of more dense scarring and scar contractures, more conventional methods having previously failed. Two of the expanders failed to achieve adequate expansion because of exposure of the device. One of the patients in whom the expander failed refused to have it reinserted. Complications included implant exposure (9 of 42), injection port exposure (1 of 42), infection (4 of 42), and a transient facial nerve palsy in 1 patient who was having her cheeks expanded. Except for one case, implant exposure did not preclude continued expansion and ultimate reconstruction.     

Management of the complications of tissue expansion during a 5-year period (2005-2010)

Abstract We report our experience of using tissue expansion where we deal particularly with complications and their management. Forty patients had tissue expanded during a 5-year period (2005-2010). Indications included reconstruction of a scar (after a burn, after injury, or postoperative), congenital naevi, microtia, and breast reconstruction after mastecomy. Of the 50 expanders inserted, complications occurred in 12 (10 patients). Exposure and perforation of the expander were the most common complications, followed by infection, seroma, and local pain. In all cases, complications were managed successfully either by conservative treatment or by a single procedure. The reconstructive plan ended in an acceptable aesthetic result in 9 of the 10 complicated areas. The insertion of multiple expanders over extensive scar tissue and particularly over the lower limb, is associated with high morbidity. Selection of patients, identification of high-risk sites, and suggestions for treatment are important. When complications occur, immediate management usually results in a successful outcome.     

Management of the complications of tissue expansion during a 5-year period (2005–2010)

Abstract

We report our experience of using tissue expansion where we deal particularly with complications and their management. Forty patients had tissue expanded during a 5-year period (2005-2010). Indications included reconstruction of a scar (after a burn, after injury, or postoperative), congenital naevi, microtia, and breast reconstruction after mastecomy. Of the 50 expanders inserted, complications occurred in 12 (10 patients). Exposure and perforation of the expander were the most common complications, followed by infection, seroma, and local pain. In all cases, complications were managed successfully either by conservative treatment or by a single procedure. The reconstructive plan ended in an acceptable aesthetic result in 9 of the 10 complicated areas. The insertion of multiple expanders over extensive scar tissue and particularly over the lower limb, is associated with high morbidity. Selection of patients, identification of high-risk sites, and suggestions for treatment are important. When complications occur, immediate management usually results in a successful outcome.     

软组织扩张术治疗大面积头面部瘢痕

目的 探讨大面积头面部瘢痕的治疗方法.方法 头部采用1～3个扩张器行头部皮肤软组织扩张术.面部瘢痕均采用胸三角皮瓣预扩张后带蒂转移修复.结果 2003年至2007年,于临床应用12例,头胸部皮肤扩张充分.其中胸三角皮瓣预扩张的2例患者.扩张器自切口处外露,但未影响手术效果;3例因扩张过程中,注水过多,致妊娠纹形成.皮瓣转移后均无血运障碍成活良好,供区直接拉拢缝合,效果满意.结论 皮肤软组织扩张术是治疗大面积头面部瘢痕的较好方法.