皮片及皮瓣移植治疗手瘢痕挛缩畸形体会

目的:对皮片及皮瓣移植术在手瘢痕挛缩畸形治疗中的疗效进行分析,证实该法确切的临床疗效。方法:以徐州仁慈医院整形美容科2010年3月~2012年3月收治的56例手瘢痕挛缩畸形患者为研究对象,用随机数字表法将其分为两组,每组28例。一组研究对象使用皮片及皮瓣移植术对瘢痕进行修复,为观察组;一组研究对象仅使用瘢痕切除和软组织松解术进行修复,为对照组。修复后对研究对象随访1年的瘢痕恢复情况及关节功能进行评价、比较及统计学分析。结果:观察组研究对象瘢痕修复良好24例,瘢痕基本消失3例,无显著改善1例,修复良好率为85.7%,高于对照组67.9%的修复良好率,且具有显著差异性(P<0.05);在关节功能恢复良好率的比较中观察组优于对照组,且具有显著差异性(P<0.05)。结论:皮片及皮瓣移植术应用于手瘢痕挛缩畸形治疗能够显著提高瘢痕修复良好率及关节功能恢复良好率,具有显著的疗效和重要的临床价值。     

游离皮瓣移植修复新鲜烧伤和烧伤瘢痕挛缩

我科自1979年以来,应用游离皮瓣、肌皮瓣移植修复新鲜深度局限性烧伤创面和烧伤晚期严重瘢痕挛缩畸形65例,现总结报道如下。 临床资料 本组65例,男42例,女23例。年龄13～45岁。其中新鲜烧伤11例,烧伤瘢痕     

会阴部瘢痕挛缩畸形45例整复治疗

目的 讨论、总结会阴部瘢痕挛缩畸形整复治疗的经验。方法 我科自1989年以来对45例会阴部瘢痕挛缩畸形患者进行了整复治疗。术前强调肠道清洁和局部瘢痕清洗；术中根据瘢痕挛缩畸形的具体情况，联合采用局部皮瓣及中厚皮片移植31例，全厚皮片移植8例，单纯用局部皮瓣移植6例；术后注意保持创面的清洁干燥和进行及时有效的功能锻炼。结果 患者在接受整复治疗后形态、功能均获得良好恢复，总优良率达95．5％。结论 根据会阴部瘢痕挛缩畸形的特殊性，重视术前准备及术后处理，合理设计、选择手术方法，才能够获得满意的治疗效果。     

口周瘢痕畸形皮瓣皮片联合移植修复

目的 探讨口周瘢痕反致畸形的皮瓣，皮片联合移植修复方法。方法 运用口周瘢痕挛缩松解、皮片移植加局部皮瓣，远位皮管等联合移植修复畸形。结果 19例烧伤后口周瘢痕畸形患者术后功能及外观均较满意。结论 对于口周瘢痕的整复，应视瘢痕厚薄情况和所在部位，根据患者病情特点运用皮片加皮瓣法或皮管法等进行联合移植修复，可能使口周的功能和外观的修复达到完美。     

游离皮片移植联合瘢痕瓣治疗会阴部瘢痕挛缩的手术疗效分析

目的:观察分析游离皮片移植联合连续Z成形术治疗周围型会阴部瘢痕挛缩畸形的疗效。方法:分析近5年来我院收治的16例周围型会阴部瘢痕挛缩患者,切除增厚质地硬的瘢痕组织,充分松解,使外生殖器及肛周组织充分复位,创面均用游离皮片移植联合瘢痕瓣连续Z成形术修复。结果:16例患者术后瘢痕瓣存活良好,15例患者游离皮片完全存活,仅1例少许皮片边缘坏死,定期换药,创面愈合。16例患者会阴部外观均明显改善,外生殖器及肛周组织完全复位,双下肢外展、下蹲、行走等功能明显改善。患者满意。结论:游离皮片移植联合连续Z成形术治疗会阴部瘢痕挛缩畸形效果满意,是修复会阴部瘢痕简单有效的方法。     

全厚皮片移植修复颈部瘢痕挛缩畸形

应用全厚皮片移植修复治疗１８３例颈部烧伤后瘢痕挛缩畸形患者，术后以３￣５年随访观察效果确切，并对全厚皮片术后易发生收缩的问题，进行讨论。     

扩张瘢痕皮片移植修复关节部位瘢痕挛缩畸形

目的:探讨应用背部扩张表浅瘢痕皮片移植修复特重度烧伤后关节部位瘢痕挛缩畸形效果.方法:选择背部有大片表浅瘢痕,四肢有瘢痕增生挛缩的特重度烧伤后患者6例.一期手术将扩张器置入背部表浅瘢痕处,按照每植皮1cm2注水7～9ml的比例注水扩张背部表浅瘢痕;二期取出扩张器,切取扩张的瘢痕皮片,去除纤维囊层后游离移植到瘢痕挛缩松解...     

髂腹股沟皮瓣在会阴部瘢痕修复中的临床应用

1992年以来我们采用髂腹股沟皮瓣加皮片移植方法修复7例儿童会阴部烧伤瘢痕挛缩,皮瓣均一期成活,取得了满意的效果。1　临床资料本组共7例,年龄5～12岁,男5例,女2例。6例为开水烫伤,1例为炭火烧伤。单侧髂腹股沟皮瓣加皮片移植4例。双侧髂腹股沟皮瓣加皮片移植3例,其中1例经延迟术,皮瓣远端达骶棘肌外侧缘。2　手术方法髂腹股沟皮瓣是以旋髂浅动脉为供血动脉的轴型皮瓣。术前用多普勒探测旋髂浅动脉穿深筋膜的位置,皮瓣的设计1旋髂动、静脉　2皮瓣　图1　皮瓣设计　图2　皮瓣掀起　以腹股沟韧带中点下方约1～2cm(儿童)股动脉搏动处为起点,斜…     

局部皮瓣与皮片移植分区修复儿童颈部瘢痕挛缩畸形

目的：探讨儿童严重颈部烧伤瘢痕畸形的手术治疗。方法：对2～11岁的颈部瘢痕畸形患者采用局部皮瓣转移与皮片移植相结合的方法，分区修复。结果：采用上述手术方法修复Ⅲ～Ⅳ度颈部瘢痕24例，其中随访23例，随访时间为6个月～2年，2例颈部后仰活动轻微受限，2例颈部瘢痕较为明显，3例所植皮片轻度挛缩，患者有紧缩感，但不影响功能。结论：对儿童严重颈部瘢痕畸形，局部皮瓣转移与皮片移植相结合分区修复为较好的手术方法。     

颈肩背轴型反流皮瓣修复儿童颏颈瘢痕挛缩

目的探讨修复儿童颏颈瘢痕挛缩一种实用而较理想的方法.方法以颈横动脉浅支为蒂,利用其与旋肩胛动脉皮支的丰富吻合,反流形成超长的轴型皮瓣,向前旋转修复瘢痕松解后的颈前创面.结果采用本皮瓣修复30例儿童颏颈瘢痕挛缩,其中18例随访2年,颈部活动自如,颌骨发育无明显异常,皮瓣色泽良好,效果令人满意.结论本皮瓣轴型血管恒定,反流灌注动脉压高有保证,供瓣面积充足,供区多可直接拉拢缝合,是修复儿童颏颈瘢痕挛缩的较理想方法.     

上臂内侧扩张皮瓣修复颈部瘢痕挛缩

目的 探讨上臂内侧扩张皮瓣的血供及用于治疗颈部不同程度的瘢痕挛缩的方法.方法 对10例患者分期手术:Ⅰ期手术时将扩张器置入上臂内侧深筋膜浅层;Ⅱ期手术时,利用尺侧上副动脉或尺侧返动脉供血、贵要静脉属支及腋静脉属支回流的上臂内侧扩张皮瓣带蒂转移修复松解颈部瘢痕挛缩后的创面;Ⅲ期时将扩张皮瓣断蒂,扩张皮瓣最大面积25 cm×15 cm.结果 移植皮瓣全部成活,皮瓣色泽及性状接近颈部正常组织,外形良好,上臂内侧供瓣区遗留较小的继发畸形.结论 将扩张器置于上臂内侧皮肤深筋膜浅层形成的扩张皮瓣用于治疗颈部瘢痕挛缩,是一个可行的方法,但分期治疗需要较长时间,在转移期间上肢与头部问的强迫体位固定的痛苦是其不足.     

采用双蒂瘢痕组织皮瓣治疗关节部位的瘢痕挛缩畸形

目的：介绍双蒂瘢痕组织皮瓣治疗关节部位的瘢痕挛缩。方法：2004年10月～2007年初,利用双蒂瘢痕组织皮瓣共治疗了5例关节部位瘢痕组织挛缩畸形的患者,1例为肘关节,2例为腋窝,2例为膝关节,手术均在伤后半年以上进行。术后随访3个月～1年,平均随访时间为6个月。结果：对所有患者,术后效果都是可以接受的。双蒂瘢痕皮瓣的优点是手术简单,皮瓣坏死可能性低,肢体固定时间短,瘢痕挛缩复发的可能性低。结论：这种双蒂瘢痕组织皮瓣可作为关节部位瘢痕挛缩治疗的选择方法之一。     

Shoulder adduction contracture after burn: Anatomy and treatment with quadrangular local scar subcutaneous pedicled flap,a new approach

Background

Axillary adduction contracture is caused by scars that tightly surround the shoulder joint impairing the function of the upper limb. Due to severe scar surface deficiency, contracture release presents a challenge for surgeons since a method of release is transfer of tissue in the form of a large pedicled or free flap(s). Thus, development of simpler, less traumatic techniques, using local tissues, persists.

Methods

Anatomic studies of shoulder adduction contractures after burn (pre-operative, during surgery, post-reconstruction) were done in 346 pediatric and adult patients. All were divided into three groups according to contracture types: with edge contractures (80%), medial (6%) and total (14%). Anatomical study covered peculiarities of total contractures and possibilities for their treatment using local scarred tissue.

Results

Total contractures (48 patients) were caused by scars tightly surrounding the joint on three sides: anterior, posterior, and axillary. There were two specific forms of contracture: (a) shoulder close to the chest wall (22 of 48 patients) which was treated with thoracic pedicled or free flaps; (b) in 26 out of 48 patients a flat scar and skin graft surface laid along the shoulder and chest wall, in axillary projection, which were used for contracture release in the form of a subcutaneous pedicled quadrangular flap. The flap was mobilized only peripherally, descending to the apex of the axilla, forming the central axillary zone, and suspension of the axilla on a normal level. Wounds aside the flaps were covered with skin graft. Acceptable functional and cosmetic results were achieved in all 26 patients.

Conclusion

Total shoulder adduction contractures have two forms: (a) shoulder close/fused with the chest wall; and (b) along the chest wall and shoulder there is a flat surface, the tissue of which can be used for reconstruction in a form of scar subcutaneous pedicled quadrangular flap. Based on this flap, a new technique is described which is relatively easy to perform.     

背阔肌游离皮瓣修复面颈部瘢痕挛缩畸形

目的:研究背阔肌游离皮瓣在修复面颈部挛缩畸形中所起的重要作用。方法:10例面颈部瘢痕彻底松解后,采用游离的背阔肌肌皮瓣治疗,将胸背动静脉分别与面动静脉吻合,供瓣区采用中厚皮片移植,其中两例采用预扩张的背阔肌游离皮瓣进行修复。结果:9例背阔肌肌皮瓣游离移植后完全存活,1例背阔肌皮瓣远端部分坏死,术后患者的面颈部功能和外形得到明显的改善。结论:背阔肌游离皮瓣修复面颈部瘢痕挛缩畸形效果可靠。     

Treatment of wide scar contracture of antecubital fossa with bipedicle flap from scar tissue

Many surgical techniques exist for reconstruction of burn scar contracture of the antecubital fossa, such as Z plasty, VY plasty, lateral arm flap, and medial arm flap. Another option is direct release of the scar contracture and skin graft of the defect area, which requires prolonged splinting and risk of graft failure. Additionally, in the areas with exposed tendons or vessels, we cannot use grafts. Recurrence of contracture remains another drawback of this treatment, in this article we present a new, simple alternative method for treatment of these cases. In this clinical trial we introduce a new technique of bipedicle flap from scar tissue for coverage of the antecubital fossa with skin grafting of the proximal and distal parts of this bipedicle flap. From July 2002 to July 2005 we used this flap in 12 patients and efficacy and versatility of this flap was studied. Seven patients were female and 5 were male with mean age of 23.7 years. The mean time between burn and our reconstructive operation was 3.2 years. The mean surface area of antecubital burn scar tissue was 77.5%. Mean extension lag before operation was 66.5 degrees , mean extension lag during operation was 4.5 degrees and after operation was 5.4 degrees . Minor complication was observed in two cases with necrosis of the flap margin. Mean follow-up period was 17 months and the appearance of operated site in antecubital fossa was acceptable in all patients. The advantage of this bipedicle flap is its simple surgical technique. The risk of flap necrosis is negligible and it is a reliable flap. Splinting time is short and the risk of recurrence of contracture with this technique is minimal.     

薄型游离旋股外侧动脉穿支皮瓣修复手足部瘢痕挛缩畸形北大核心CSCD

目的探讨薄型游离旋股外侧动脉穿支皮瓣修复手、足部瘢痕挛缩畸形的疗效。方法 2017年1月—2020年10月,收治15例手、足部瘢痕挛缩畸形患者。男9例,女6例;年龄6~42岁,中位年龄23岁。瘢痕挛缩时间1~21年,中位时间13年。瘢痕挛缩畸形位于手部11例、足部4例;导致不同程度手、足部关节功能障碍。术中瘢痕挛缩松解后遗留创面范围为6 cm×4 cm~9 cm×8 cm;合并血管、神经或者肌腱外露12例,肌腱缺损4例。经浅筋膜浅层切取薄型游离旋股外侧动脉穿支皮瓣修复,皮瓣切取范围为6.0 cm×5.0 cm~10.0 cm×8.5 cm;取阔筋膜条重建肌腱。皮瓣供区减张缝合。结果术后1例皮瓣出现静脉血管危象,经对症处理后皮瓣成活;其余皮瓣均顺利成活,创面Ⅰ期愈合。皮瓣供区切口均Ⅰ期愈合。患者均获随访,随访时间6~12个月,平均9个月。皮瓣外形、质地良好。患手功能明显改善,末次随访时按照中华医学会手外科学会上肢部分功能评定试用标准,获优7例、良4例。患足足趾关节畸形及功能均明显改善。供区无肌疝、感觉麻木等并发症发生。结论经浅筋膜浅层切取的薄型游离旋股外侧动脉穿支皮瓣修复手、足部瘢痕挛缩畸形松解后创面,可获得良好外观及功能,而且供区并发症少。