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。

PREVENTION AND TREATMENT OF POSTOPERATIVE COMPLICATIONS AFTER SKIN SOFT TISSUE EXPANSION FOR SCAR ALOPECIA

Objective To summarize the prevention and treatment of postoperative complications after the skin soft tissue expansion for scar alopecia.Methods From January 1995 to June 2005,57 patients with scar alopecia were admitted to our department for treatment.Of the patients,25 were males and 32 were females with their ages ranging from 5 to 55 years.The causes were burn in 33 patients,trauma in 14,alopecia after head surgery in 8,and other causes in 2.Their disease courses ranged from 6 months to 15 years.For treatment,89 therapeutic expanders were utilized in 57 patients.The retrospective analysis on the complications and their prevention and treatment were performed.Results The follow-up for 3-12 months averaged 6 months revealed that 81 areas undergoing the expander insertion healed well and the hair grew well,too.Eight areas undergoing the expander insertions had complications,including expander exposure in 2 patients,infection in 2,hematoma in 1,expander rupture in 1,necrosis of the flap tip in 1,and scar necrosis at the injection port in 1.The results also revealed that there was a significantly increased rate of complications in the patients aged 5-10 years and the patients older than 50 years(P<0.05).The complication rate in the patients who received 2 expanders at one time was significantly higher than that in the patients who received only 1 expander(P<0.05).However,there was no significant difference in the complication rate in the other kinds of patients.All the complications were effectively treated with a satisfactory therapeutic result.Conclusion The skin soft tissue expansion for scar alopecia can effectively prevent and treat postoperative complications.If the complications are identified early and treated properly,the therapeutic results will be satisfactory.