扩张皮片在大面积游离植皮中的临床应用

目的:拓展大面积游离植皮术的皮肤来源,减少供皮区的创伤。方法:采用微创切口于胸背部皮下浅层置入600～1 000ml的大型扩张器,间断注入生理盐水,超量灌注行皮肤扩张。注水完成1个月后视受区刨面切取扩张皮肤,修剪为全厚或厚中厚皮片植入,供皮区创面直接缝合。结果:1999年以来,采用本术式治疗手、面、颈等部位的大面积瘢痕患者共32例,植皮成活面积平均为97.94％,供皮区切口均为I期甲级愈合。术后随访24例,平均时间为10个月,22例皮片收缩面积低于5％,皮片色泽及质地较佳,2例4个月时收缩面积为30％左右。结论:扩张皮肤用作游离植皮,其成活率及成活后的生物学性质较传统植皮差别不大,对需大面积植皮而供皮区相对局限、供皮区创面不易愈合的瘢痕患者尤其试用。大型扩张器微创切口置入,刀口裂开机率低。

Applications of expanded skin in large-sized skin graft

Objective: To introduce a method for supply of large - sized skin graft, in the mean time, to save injury to donor site. Methods: A 600 - 1000ml expander was implanted in the back subcontaneously through a small incision with minimum trauma, natural saline was infused at interval and the overlying skin was overex-panded. The expanded skin was harvested in accordance with demand of receipt site one month after final infusion. The harvested skin was thinned into thick split thickness or full thickness skin for grafting. The donor site wound margins were approximated and sutured. Results; The method has been adopted to treat thirty - two cases with large-sized scar in the hand, face, and neck since 1999. Mean graft vitality was 97.94% . All the donor site had I/A healing. Twenty - four cases were followed up postoperatively. Mean follow - up time was ten months. The skin graft contraction was less than 5% in twenty- two cases. The colour and texture match was good. Only two cases experienced a graft contract of about 30% four months after operation. Conclusions: There is little difference in vitality and biological properties between the expanded skin graft and that harvested by conventional techniques. The method is very suitable for the patients when the donor sites are limited and difficult to heal due to scar. A large expander is introduced through a small incision. Therefore, wound dehiscence is rare.