皮肤软组织即时扩张术的临床应用

为探讨在确保治疗效果的前提下如何缩短疗程及减少并发症的发生，自１９９２４上９以来，欠组织即时扩张术分别用于颜面、胸前、前臂及背部因瘢痕、色素痣及血管瘤切除后皮肤软组织缺损创面的即时修复，共２５例，效果良好，对即时扩张术的手术方法，适应证和注意事项进行了讨论认为在充分估计缺损区大小及即时缩较重的情况下，即时扩张术不失为修复小面积皮肤缺损的一种较好方法。     

术中即时扩张在急诊皮肤软组织缺损修复中的应用

目的:探索术中即时扩张技术在急诊皮肤软组织缺损修复中应用的可行性。方法:笔者对86例急诊皮肤软组织缺损(缺损面积在3cm×4cm～12cm×8cm)的患者,采取该技术进行术中即时扩张,一期修复皮肤软组织缺损。结果:本组86例患者,应用该技术均一次性达到了修复目的,术后随访6个月～3年,所有患者局部皮肤色泽及厚薄与周围正常皮肤一致,瘢痕不明显。结论:术中即时扩张技术可以运用于皮肤软组织缺损的修复。它是一种简单、安全而行之有效的治疗方法,可以运用于临床,尤其在基层医院。     

皮肤软组织扩张术在头面颈部的应用

目的：探讨提高皮肤软组织扩张术修复头面颈部组织器官缺损的手术效果及并发症的防治。方法：采用国产硅橡胶扩张器行皮肤扩张术,修复耳鼻和头面颈部软组织缺损。结果：本组病例除一例因扩张囊外求战导致扩张失败外,其余病例均取得了良好的术后效果。结论：采用皮肤软组织扩张术修复头面颈部皮肤缺损。术后效果明显优于其它方法。     

软组织扩张术修复鼻缺损的护理

软组织扩张术是使用皮肤软组织扩张器，植入皮肤软组织下，通过逐渐增加扩张器内容量，对表面皮肤产生压力，使皮肤组织增生、扩张，产生“额外”的多余皮肤软组织，用于修复软组织缺损的一种方法。这项技术使许多患者得到了前所未有的良好治疗效果。我科自2003年1月-2004年12月共收治鼻部缺损患者19例，采用软组织扩张术修复缺损，行两次手术，一为扩张器植入术，二为扩张器取出，皮瓣转移修复术。我们根据术后观察护理指标项目多，要求高的特点，对患者实施程序化护理和全程护理，术后愈合好，修复效果满意。现报告如下。     

96h快速皮肤软组织扩张术

目的 缩短扩张疗程、减少并发症，提高扩张效果。方法 自１９９６年以来，选择中小 皮肤软组织缺损，通过改变注水时间及注水量，进行了３８例９６ｈ快速皮肤软组织扩张术。结果 所有皮肤软组织缺损均获得满意修复，随访半年，手术切口瘢迹纤细。结论９６ｈ快速皮肤软组织扩张术，简单安全、经济方便、快速可靠；本术式已趋成熟，易于推广，是一种较扩张术式。     

皮肤软组织扩张术治疗瘢痕的应用

目的 总结皮肤软组织扩张术治疗瘢痕的临床经验，以提高疗效。方法 自2001年以来。应用皮肤软组织扩张术治疗多种病变造成的瘢痕患者12例，术中依据瘢痕情况设计埋置扩张器的大小、形状及埋置方式，Ⅱ期行皮瓣转移修复缺损区。结果 所有患者的瘢痕全部修复，随访6个月至2年，疗效满意。结论 应用皮肤软组织扩张术治疗全身各处瘢痕。效果肯定。通过总结临床经验，有助于提高皮肤软组织扩张术的临床应用效果。     

皮肤接力扩张术的临床应用

皮肤软组织扩张术目前已广泛应用于临床，但修复大面积皮肤软组织缺损存在着手术次数多，病人痛苦大，病程长等缺点。笔者应用皮肤接力扩张术修复大面积皮肤缺损取得了良好的临床效果，现总结报告如下。     

即时扩张皮瓣修复四肢小面积皮肤缺损的效果

目的评价即时扩张皮瓣在修复四肢小面积皮肤缺损中的治疗效果。方法对32例四肢小面积皮肤缺损患者,术中于缺损两侧皮下预置自制简易扩张器,术中即时扩张30～45 min,必要时可间隔5～10 min后行再次扩张1次,然后取出扩张器,Ⅰ期修复皮肤缺损。结果患者均获随访,时间1～18个月。31例四肢皮肤缺损获Ⅰ期修复愈合,1例切口脂肪液化,加强换药后获愈合;皮瓣均无坏死。结论术中即时扩张皮瓣治疗四肢小面积皮肤缺损是一种简单、经济、实用的修复方法。     

皮肤软组织扩张术在上肢外科的应用

目的 总结皮肤组织扩张术修复与重建皮肤软组织与深部组织的应用价值。方法 对２０例创伤后皮肤软组织及深部结构损伤者,利用皮肤软组织扩张术首先修复皮肤软组织,待扩张器取出时即刻修复皮肤缺损与重建深部缺损的组织。重建手术包括肌腱移位、构解术,周围神经移植及／或松解术,关节松解术,截肢残端修整术等。结果 术后６个月随访,重建的皮肤在质地、色泽、弹性等方面与正常皮肤相近;肌腱松解术后肌腱活动度恢复的优良率达到８７．５％（ＴＡＭ法评价）。结论 传统方法将修复创伤后皮肤软组织与重建深部组织缺损分二期进行。皮肤软组织扩张术具有缩短疗程、提供扩张后增加的皮肤面积及同期重建功能的优点。     

术中即时扩张术的临床应用

采用术中即时扩张的方式，为１４例因烧伤瘢痕和色素痣切除术后皮肤软组织缺损进行直接缝合修复，取得了良好效果。对手术方法、适应证和注意事项进行了讨论。认为这是一种简便易行的方法。     

表皮生长因子导入治疗在皮肤扩张器中的应用研究

目的:探讨使用导入仪导入重组人表皮生长因子(rhEGF)促进皮肤扩张的临床效果。方法:自2013年1月~2013年5月入选38例患者,共将76个扩张器进行埋置,按照随机原则,分为常规注水对照组(36个扩张器)与导入仪导入治疗组(36个扩张器)。治疗组的扩张器在每次注水扩张的第二天进行导入仪治疗,在被扩张的皮肤表面涂抹rhEGF并使用导入按摩仪进行按摩导入。对照组的扩张器仅进行常规的注水。测量两组扩张器扩张致额定容量所花费的时间、皮肤扩张比率及扩张皮肤即刻回缩比率,采用自身对照的方法进行比较分析。进行胶原含量,I/III型胶原比率(%)的测定和病理HE染色分析。结果:注水后第二天进行rhEGF导入治疗能使扩张器扩张致额定容量所花费的时间明显缩短,皮肤扩张比率则明显增加,扩张皮肤即刻回缩比率减少,有效减小皮辨的即时回缩率。治疗组胶原纤维束粗而密,I/III型胶原比例降低。结论:注水后第二天通过使用导入仪将rhEGF导入扩张皮肤治疗能缩短扩张时程,促进皮肤的面积增加,降低皮瓣回缩的比率,提高皮瓣质量,改善治疗效果。     

维持扩张期对扩张皮肤张力和即时回缩率影响的研究

目的：研究维持扩张期对扩张皮肤在体张力和即时回缩率的影响，并以此指导临床。方法：以狗为动物模型，在6只成年大狗的背侧，对称设计6个区域。实验分为注水2周组、6周组、实验对照组和空白对照组。分析比较各组的在体张力和即时回缩率（包括有包膜和去包膜）。结果：皮肤在体张力和即时回缩率随着维持期的延长逐渐缩小，而注水期的长短对其影响不大；去除包膜后皮肤的在体张力和即时回缩率明显降低。在此基础上，临床应用16例23个扩张器的效果较好。结论：在皮肤软组织扩张术中，可以通过缩短注水期（2周左右）、适当延长维持期（4周）以及去包膜的方法，可以达到减少扩张皮肤的在体张力和即时回缩率，增加扩张皮肤面积的目的。     

每次反复注水快速皮肤扩张法的实验研究

目的　探讨最佳的皮肤扩张法,了解每次反复注水快速皮肤扩张法的效果及机理。方法　白色乳猪4只,在脊柱两侧各设计3个皮瓣组,分别为每次反复注水快速扩张组、常规扩张组、对照组,在监测囊内压的情况下定期扩张,扩张结束后分别测定和比较扩张总面积、时间、皮肤的即时回缩率以及囊内压的变化,并进行组织学及超微结构的观察。结果　每次反复注水快速扩张组扩张后总面积明显大于常规扩张组（P＜0.05）,皮肤即时回缩率与常规扩张组间无明显差异（P＞0.05）,扩张总时间短于常规扩张组,扩张前囊内压在每次反复注水快速扩张组与常规扩张组间差异无显著性（P＞0.05）,每次反复注水快速扩张组扩张后皮肤的超微结构及功能与常规扩张组无明显区别。结论　每次反复注水快速皮肤扩张法是一种有效的、安全的方法,可在临床上推广应用。     

Intraoperative Expansion of Skin Around Large Congenital Naevi with Foley Catheter Balloons: 11 New Cases

Tissue expansion allows reconstruction of large cutaneous defects with adjacent skin, similar in appearance and type, without using skin grafts or multiple, regional, distant, or microsurgical flaps. Conventional expansion produces a greater increase in surface and length than intraoperative expansion, but it has several disadvantages and should be reserved for closing problematic defects. There is considerable controversy about the relative effects of intraoperative expansion and undermining on the tensions of closing wounds, although immediate expansion is commonly used particularly in head and neck reconstruction. New multiple external devices have recently been described to expand skin externally, but there are few options as internal expanders. We have chosen multiple Foley catheter balloons, because of their availability and low cost, to repair 11 limb defects after excision of large naevi. The wounds are easy to close, primarily, and postoperative results are good. Dark pigmentation scars are the most common possible complications.     

Intraoperative expansion of skin around large congenital naevi with foley catheter balloons: 11 new cases.

Tissue expansion allows reconstruction of large cutaneous defects with adjacent skin, similar in appearance and type, without using skin grafts or multiple, regional, distant, or microsurgical flaps. Conventional expansion produces a greater increase in surface and length than intraoperative expansion, but it has several disadvantages and should be reserved for closing problematic defects. There is considerable controversy about the relative effects of intraoperative expansion and undermining on the tensions of closing wounds, although immediate expansion is commonly used particularly in head and neck reconstruction. New multiple external devices have recently been described to expand skin externally, but there are few options as internal expanders. We have chosen multiple Foley catheter balloons, because of their availability and low cost, to repair 11 limb defects after excision of large naevi. The wounds are easy to close, primarily, and postoperative results are good. Dark pigmentation scars are the most common possible complications.     

Immediate versus chronic tissue expansion

A quantitative comparison of the effects on tissues is performed between chronic tissue expansion, intraoperative expansion, and load cycling in a guinea pig model. Intra-operative expansion, which was developed by Sasaki as a method of immediate tissue expansion for small- to medium-sized defects, and load cycling, which was described by Gibson as a method using intraoperative pull, are compared with chronic tissue expansion on the basis of the following four parameters: amount of skin produced, flap viability, intraoperative tissue pressures, and histological changes. The chronically expanded group, which included booster and nonbooster expansions, produced a 137% increase in surface area, or a 52% increase in flap arc length, whereas intraoperative expansion resulted in a 31% increase in surface area, or a 15% increase in flap arc length. The load-cycled group, however, resulted in an almost negligible amount of skin increase. All three techniques exhibit immediate postexpansion stretchback. Flap viability is not impaired by any of the three techniques, in spite of the elevated pressures observed during expansion. Therefore, intraoperative expansion is effective primarily for limited expansion of small defects, whereas chronic tissue expansion still provides the greatest amount of skin increase when compared with other techniques.     

Dimethylsulfoxide (DMSO) for human single-stage intraoperative tissue expansion and circulatory enhancement

Dimethylsulfoxide (DMSO) has been in clinical use since the early 1960s. In 1967 the discovery that DMSO can greatly reduce ischemia in experimental pedicle flaps stimulated its use in plastic surgery by the authors since 1976. In 1987 its ability to soften collagen, thus permitting degrees of immediate intraoperative tissue expansion hitherto unknown, was applied clinically for the first time. Evolving use of topical 70% DMSO alone, in combination with intravenous DMSO, and intravenous DMSO alone with greater efficacy is discussed. Cases of intraoperative tissue expansion for large lesion excision and use in abdominoplasty to maximize skin resection are discussed. In breast reconstruction, maximal tissue expansion in minutes with immediate placement of large permanent prostheses ends the delay of reconstruction and problems of chronic tissue expander capsule formation and gives this technique a clear advantage over other reconstructive techniques.     

术中即时扩张术的临床应用

采用术中即时扩张的方式,为14例因烧伤瘢痕和色素痣切除术后皮肤软组织缺损进行直接缝合修复,取得了良好效果。对手术方法、适应证和注意事项进行了讨论。认为这是一种简便易行的方法。     

Dimethylsulfoxide (DMSO) for human single-stage intraoperative tissue expansion and circulatory enhancement

Dimethylsulfoxide (DMSO) has been in clinical use since the early 1960s. In 1967 the discovery that DMSO can greatly reduce ischemia in experimental pedicle flaps stimulated its use in plastic surgery by the authors since 1976. In 1987 its ability to soften collagen, thus permitting degrees of immediate intraoperative tissue expansion hitherto unknown, was applied clinically for the first time. Evolving use of topical 70% DMSO alone, in combination with intravenous DMSO, and intravenous DMSO alone with greater efficacy is discussed. Cases of intraoperative tissue expansion for large lesion excision and use in abdominoplasty to maximize skin resection are discussed. In breast reconstruction, maximal tissue expansion in minutes with immediate placement of large permanent prostheses ends the delay of reconstruction and problems of chronic tissue expander capsule formation and gives this technique a clear advantage over other reconstructive techniques.Presented at the 23rd annual meeting of the American Society for Aesthetic Plastic Surgery, Chicago, Illinois, USA, April 2, 1990