Unilateral cervical burn scar deformity elimination with contralateral cervicothoracic flap--a new approach

Unilateral postburn cervical deformity is a severe cosmetic and functional defect and a challenging reconstructive problem. Many flaps have been suggested; however, after surgery, operational scars, located along the anterior neck's middle line, and the flap's skin differ from cervical healthy skin. A small flap resembles a patch. A more effective and safer technique is neck resurfacing with cervicothoracic adipocutaneous flap which had been used by the author in 32 burned patients. The flap's peculiarities are as follows: axis blood circulation via superficial cervical artery perforator; exclusion of platysma (flap is thin and elastic); and undamaged donor site. The mobilized healthy neck's skin with thin fat layer and adipocutaneous layer of the chest wall are elevated as a whole large flap. After scar excision, the cervicothoracic flap is advanced on the wound with tension. As a result of flap tension, the skin of neck's back, thoracic wall, and axilla are displaced to the anterior neck surface covering the donor wound. On an average, 6 cm of the deformed neck anterior surface was restored. No flap loss but only local superficial scar necrosis along the flap's border occurred. The cervical contracture and scar deformity (25 patients) were eliminated in all cases by a single procedure. For complete neck skin restoration, seven patients underwent staged reconstruction using the same technique. Excellent functional and good cosmetic follow-up results were achieved. The proposed technique is easy to plan and perform and yields good results; therefore, the author believes that the contralateral cervicothoracic flap's use is an exclusive option for unilateral cervical contracture and deformity elimination in adults and pediatric patients.     

The island myocutaneous flap reconstruction in electrical burn injuries of severely traumatized cervical region

Trauma patients with high-energy injuries often present with severe tissue damage that extends beyond the immediate zone of injury and require recruitment of vascularized and massive tissues. The objective of this study was to evaluate the utility of the island myocutaneous flap for the reconstruction of the electrical burn injuries on the cervical region. We conducted a retrospective chart review on all trauma patients treated by the Department of Plastic Surgery at Changhai Hospital, Second Military Medical University who required a large amount of vascularized tissue for the reconstruction of the electrical burn injuries on the cervical region from July 1994 to June 2006. Of them, 23 patients underwent reconstruction of severe traumatic deformities and disfunction on the cervical region with 23 island myocutaneous flaps from adjacent regions. Of the 23 patients, 17 were male and 6 were female, with an average age of 38 years. Conservative surgery method for debriding necrotic tissues and three different types of island myocutaneous flaps, including pectoralis major island myocutaneous flap, latissimus dorsi island myocutaneous flap and trapezius island myocutaneous flap were used. The defect area ranged from 6 cm x 4 cm to 20 cm x 15 cm. The sizes of the dissected myocutaneous flap ranged from 8 cm x 6 cm to 35 cm x 15 cm. All the 23 cases acquired complete recovery. The secondary defect of donor areas had primary closure after being directly sutured or covered with skin grafts. Island myocutaneous flaps have distinctive advantages in treatment of electrical burn injuries on cervical region and it can obtain satisfactory functional and cosmetic outcomes.     

烧伤后手指和指蹼挛缩畸形的治疗及功能康复

目的：探讨烧伤后手指和指蹼挛缩畸形的手术治疗和功能康复方法。方法：本组33例45只伤手，采用瘢痕切除或切开加皮片移植术修复127个手指挛缩畸形，采用局部皮瓣或皮片移植术分别修复36只和60只指蹼畸形。手术后早期进行关节功能训练、按摩、弹力手套压迫等康复治疗。结果：皮片移植和皮瓣全部成活，手指间关节和掌指关节功能、指蹼功能均有改善，皮瓣法修复指蹼优于皮片法。通过功能康复治疗，87．9％患者生活能够完全或大部分自理。结论：对烧伤后手指瘢痕挛缩畸形采用手术和功能康复治疗可取得较好的效果，手指侧方皮瓣修复指蹼畸形，手术简单可靠．效果好。     

Fiberoptic‐guided tracheal intubation under precise anesthesia and topicalization with spontaneous respiration preservation for an uncooperative patient with severe postburn mentosternal contracture

Airway management of patients with difficult airways is a challenge to the anesthesiologists and awake tracheal intubation is the recommended strategy. Successful fiberoptic‐guided tracheal intubation under precise anesthesia and topicalization with spontaneous respiration preservation was achieved in an uncooperative patient with severe postburn mentosternal contracture scheduled for release of contracture.     

Postburn edge shoulder adduction contracture: anatomy and elimination with trapeze-flap plasty-a new approach

Postburn scar shoulder adduction contracture is the most common among big joints' contractures. As the contracture impedes all upper limb function, surgical reconstruction is indicated as early as the contracture is formed. Many flaps and techniques have been suggested, yet the problem is not resolved completely. Three hundred forty-six edge scar shoulder adduction contractures were eliminated personally in 277 patients. Contracture anatomy was studied before and during surgery. Effectiveness of the existing and newly developed techniques was evaluated. Edge shoulder scar adduction contracture is caused by scars located on anterior and/or posterior shoulder joint surface and is characterized by the presence of the fold along the axillary fossa edge. Crest of the fold is the edge of scars. The fold's lateral sheet is scars (causes contracture); medial sheet and axillary fossa skin stay uninjured. Lateral scar sheets have surface deficit in length; the deficit spreads from the fold's crest to the shoulder joint rotation axis and has a trapezoid form. The conclusion was made that the adequate technique should consist of sheet surface deficit compensation with the flap of the same (trapezoid) shape. The medial fold sheet and axillary fossa served as an excellent donor site for the flap. Depending on contracture severity, several variants of the trapeze-flap plasty were developed: trapeze-flaps alone or in combination with skin grafts. In all cases, contractures were eliminated completely with trapeze-flap plasty without serious complications. No flap loss and contracture recurrence took place. The proposed techniques are based on the anatomy of the contracture. They are easy to plan and perform, allow complete restoration of the upper limb's function, and improve shoulder joint region appearance in general. The author believes that the trapeze-flap plasty procedure is a preferred technique for adult and pediatric patients with edge scar shoulder adduction contracture.     

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。     

Tissue-expanded radial forearm free flap in neck burn contracture

Neck contracture after burn injury can result in severe functional as well as aesthetic deformities. Contracture can recur even after wide and complete release and full-thickness skin grafting. Recurrence is partly due to the inherent difficulties in both early postoperative immobilization and the required long-term splinting. When adjacent tissues are also burned, adequate local tissue for reconstruction may not be available; therefore, free-tissue transfer may be necessary. The large surface area that is required after adequate release may be provided by tissue expansion before free-tissue transfer. In the case presented the use of tissue-expanded radial forearm free flap for the reconstruction of a recurrent neck contracture is described.     

桡动脉掌浅支蒂的腕掌侧嵌合骨皮瓣带蒂转移修复拇指复合组织缺损

目的探讨桡动脉掌浅支蒂的腕掌侧嵌合骨皮瓣带蒂转移修复拇指复合组织缺损的效果.方法回顾分析我院2017年2月至2019年4月期间收治的拇指复合组织缺损修复患者30例,均接受桡动脉掌浅支蒂的腕掌侧嵌合骨皮瓣带蒂转移修复,随访患者6个月,分析治疗结果.结果本研究30例患者皮瓣均成活,未出现切口开裂、皮瓣坏死、血运障碍等状况,均接受6-10个月随访,平均为(8.3±1.1)月.术后5周左右,均拔除克氏针,骨折线模糊,术后1.8个月时,骨折线消失,骨折愈合.术后6个月时,患指皮瓣辨别觉为(7.2±1.8)mm,腕关节可正常屈伸,仅1例患者腕横纹部位存在轻微线状瘢痕,各患者均未出现骨折移位、骨坏死、骨髓炎、皮瓣坏死、伤口感染、关节僵硬、功能障碍、瘢痕挛缩等.结论临床治疗拇指复合组织缺损,采用桡动脉掌浅支蒂的腕掌侧嵌合骨片带蒂转移方式,此方式操作简单,可满足组织恢复所需供血,愈合速度快,且供区瘢痕较为隐蔽.     

软组织扩张术乳头再造法治疗乳头缺失疗效观察

目的 探讨软组织扩张术乳头再造法治疗乳头缺失的可行性。方法 采用软组织扩张法，即在残存乳头及乳晕区皮肤软组织下埋置扩张器，注水扩张，进而形成乳腺组织瓣作支撑，行乳头再造。结果 本组5例患者，行10侧乳头再造术后均取得了良好效果。结论 软组织扩张术乳头再造法能充分利用局部组织材料资源，减少额外创伤，且符合人体生理结构，是一种较理想的乳头再造方式。     

A new finger fillet design from an index finger with severe postburn flexion deformity

Treatment of postburn deformities of the hand is a real challenge to reconstructive surgeons. A functional reconstruction was achieved with two sensate island flaps on two discrete pedicles in a case with severe postburn deformity involving both thumb and index finger. Surgical treatment was based on amputation of the second ray and reconstruction of the thumb with the flaps derived from the discarded index finger. Two sensate island flaps on two discrete pedicles, "1st dorsal metacarpal artery based flap" from the dorsal aspect of the proximal phalanx and "palmar digital artery based fillet flap" composed of available volar skin of the index finger distal to contracture, were harvested and used for replacement of the soft tissue defect of the thumb that appeared after correction of bone and joint deformities. Both of the flaps survived and functional improvement was satisfactory at one-year follow-up. Despite the shortening of neurovascular bundles due to severe flexion deformity, a sensate thumb reconstruction with a better tissue match was achieved thanks to more beneficial design and orientation of two neorovascular island flaps from a deformed index finger. Instead of a single fillet flap design in its common use, our current approach allowed more beneficial use of a discarded index finger in severe postburn deformity involving both thumb and index finger.     

Tissue expansion in the treatment of hypertrophic scars and scar contractures

The temporary tissue expander can generate an excess of full-thickness skin that can be recruited into an adjacent area of tissue deficiency caused by scar contracture. The creation of a pseudobursa enhances the functional improvement gained by this technique. Now in its developmental stage, tissue expansion carries an alarming complication rate (33%), but we expect refinements in technique to diminish this percentage.     

腓肠神经营养血管逆行皮瓣修复断裂跟腱术后感染伴皮肤缺损

背景：跟腱位置表浅,皮肤血供较少,开放性损伤后污染较重,难以彻底清创,修复后易发生感染及局部皮肤缺损、肌腱外露,传统换药治疗效果不佳。 目的：探讨腓肠神经营养血管逆行皮瓣联合负压封闭引流技术治疗跟腱断裂术后感染伴皮肤缺损的临床经验。 方法：选择2009至2012年佛山市第二人民医院收治的13例跟腱断裂术后感染、皮缘坏死患者,其中男8例,女5例;年龄25-65岁;跟后皮肤缺损4 cm×5 cm-7 cm×6 cm。经过扩创、负压封闭引流治疗,待创面肉芽组织新鲜、感染控制后,跟后皮肤缺损采用自体腓肠神经营养血管逆行皮瓣修复。随访观察创面愈合情况。 结果与结论：13例患者移植皮瓣均成活,创面均获得一期愈合。随访9-14个月,移植皮瓣无继发坏死、感染,皮肤质地及弹性良好,蒂部无明显臃肿。随访后6个月时,采用美国足踝外科学会评分系统评价踝关节功能显示优良率为90%。提示运用负压封闭引流技术可有效控制感染,腓肠神经营养血管逆行皮瓣为跟腱外露提供了良好的覆盖,皮瓣外观、血运、质地、弹性佳,局部无明显瘢痕挛缩,踝关节功能恢复良好。     

The use of a tissue expander to enlarge a graft for surgical treatment of a pressure ulcer in a quadriplegic. Case report

This case reports the use of a tissue expander to facilitate the surgical closure of a decubitus ulcer in a spinal cord injured quadriplegic. The patient is a 42-year-old man with chronic nonhealing of a right ischial pressure ulcer. It had required a flap rotation and partial ischiectomy in the remote past that had been problem-free for many years. The patient subsequently required the placement of a new flap, but insufficient tissue was available to close the wound with the hip in 90 degrees of flexion. Closing the wound with the hip in extension merely led to breakdown when the hip was put in the 90 degrees of flexion required for the sitting position. The problem was solved by using a tissue expander to increase the available soft tissue. A tissue expander was inserted and gradually expanded over a period of weeks by injecting it with fluid. It was then removed, and the expanded tissue that had grown over it allowed closure of the wound without tension on the tissues with the hip in flexion. The patient subsequently returned to the sitting position and his work as a computer programmer. Tissue expanders are commonly used in breast reconstruction, but have found many other uses in plastic surgery over the last decade. It is felt that tissue expansion techniques should not be the primary surgery treatment of decubitus ulcers, but can be used in difficult cases like this one to provide additional tissue.     

超量皮肤扩张术在治疗颈部中重度瘢痕挛缩畸形的应用研究

目的探讨超量皮肤扩张术在治疗颈部中重度瘢痕挛缩畸形中的效果。方法64例患者随机分为观察组（33例）和对照组（31例）,观察组采用颈部皮肤超量扩张术治疗,对照组采用背阔肌肌皮瓣转移术治疗,比较两种术式临床疗效。结果观察组患者颈部肤色好,挛缩瘢痕得到松解,效果明显优于对照组。结论颈部超量扩张术治疗颈部中重度瘢痕挛缩畸形安全,有效。     

应用预构皮瓣治疗颜面部大面积烧伤后瘢痕患者的护理体会

目的探讨应用预构皮瓣治疗颜面部大面积烧伤后瘢痕患者的护理方法。方法便利抽样法选取2015年10月至2016年2月在上海交通大学附属第九人民医院整复外科行预构皮瓣技术治疗颜面部大面积烧伤后瘢痕患者9例,做好扩张器植入期、注水期以及预构皮瓣转移术的术前、术后护理。结果 8例颜面部大面积烧伤后瘢痕患者应用预构皮瓣治疗成功,成功率达到88.9%;1例患者部分皮瓣坏死,经重新修复治疗后痊愈。结论系统、规范地观察及护理可预防和减少预构皮瓣治疗颜面部大面积烧伤后瘢痕患者并发症的发生,避免患者再次手术的痛苦;及时的心理护理可以缓解患者负面心理情绪,增强患者治疗的信心。     

皮肤扩张器在头面部大面积皮肤病损治疗中的应用

目的:探讨皮肤扩张器在头面部大面积皮肤病损治疗中的临床应用。方法:使用皮肤扩张器治疗16例头面颈部大面积皮肤病损患者。选用100～500 ml容量的扩张器植入病损旁的皮下,注射壶内置,注水扩张6～8周。Ⅱ期手术取出扩张器,将扩张皮瓣用滑行推进或旋转推进方式修复切除病损之创面。结果:16例患者共治疗24处病损,置入扩张器39个,一次修复最大面积为12 cm×18 cm,所有患者均得到有效治疗;扩张期发生并发症2例,为术后血肿及扩张器外露,发生率约5%。结论:应用皮肤扩张器修复头面部大面积病损是一种理想的方法,但应重视并发症的预防。     

Free flap transplantation combined with Ilizarov bone transport for the treatment of severe composite tibial and soft tissue defects

ObjectiveTo evaluate the clinical efficacy of free flap transplantation combined with Ilizarov bone transport in the treatment of severe composite tibial and soft tissue defects.MethodsWe retrospectively analyzed the clinical data of 40 patients with severe composite tibial and soft tissue defects who underwent free flap transplantation combined with Ilizarov bone transport. The clinical efficacy was evaluated according to the following criteria: success rate of wound repair by free flap transplantation, incidence or recurrence rate of deep infection, healing rate of bone defects and external fixation index, incidence of complications, and functional score of affected extremities.ResultsAll infections were generally well controlled by radical debridement and negative-pressure therapy, and all 40 patients’ wounds healed after repair and reconstruction of the tibia and soft tissues. Postoperative complications were alleviated by active treatment. The mean external fixation time was 12.83 ± 2.85 months, and the external fixation index was 1.55 m/cm. According to the Association for the Study and Application of Methods of Ilizarov (ASAMI) score, an excellent or good functional outcome was attained in 85% of patients.ConclusionFree flap transplantation combined with Ilizarov bone transport is an effective treatment for severe composite tibial and soft tissue defects.     

不同类型颈部烧伤疤痕手术方法探讨

目的 :观察不同手术方法 ,手术时间修复不同类型颈部烧伤疤痕挛缩畸形的临床疗效。方法 :对 12 3例不同类型颈部烧伤疤痕挛缩畸形施行 7种不同的手术方法 ,其中 41例儿童采用伤后 3种不同的手术时间修复 ,同时观察 44例不同厚度皮片移植术后半个月至 1年内 5个不同时期的皮片收缩率。结果 :安全简单的局部、邻近皮瓣修复效果最好 ;局部、邻近皮瓣辅以皮片移植修复优于单纯皮片移植 ;移植的皮片越厚 ,皮片术后收缩率越低 ;全、中厚皮片移植术后收缩率以 14d至半年尤其 3个月内为最高 ;儿童半年以上延迟手术会影响颜面部和脊柱的正常发育。结论 :早期选择合理的手术方法、手术时间与抗皮片挛缩治疗颈部烧伤疤痕挛缩畸形 ,能有效地防治疤痕挛缩 ,减轻 (少 )继发畸形的发生     

Management of pediatric perineal and genital burns: twenty-year review

Between 1966 and 1986, fifty-seven pediatric patients with partial and/or full-thickness perineal and genital burns with a minimum of 1-year follow-up were identified. Fifty percent of the patients with genital burns and 20% of the patients with perineal and/or buttock burns required skin grafting in the acute stage. No patient required suprapubic cystostomies, diverting colostomies, or local flap coverage of exposed testicles. Burn scar contractures were the most frequent complications. Thirty-two patients (56%) required contracture release of the perineum and coverage with either skin grafts or local skin flaps. In three patients (6%) contracture required release of the penis and scrotum. One patient lost a testicle. Three patients developed rectal prolapse and were treated without surgery. Four patients developed rectal stenosis with fecal incontinence because of burn scar contracture and were treated by anal dilatation, local transposition flaps, and/or excision of the scar and primary closure. Acute management of pediatric patients with such injuries can be conservative. Delayed complications of contractures of the perineum and genitals can be easily corrected with scar excisions, skin grafts, or the use of local skin flaps.     

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。