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。

Skin and soft tissue expansion in the surgery of upper extremity

Objective To apply skin and soft tissue expansion in post traumatic reconstruction of skin, soft tissue and deep structure in the upper extremities. Methods Skin and soft tissue expansion was performed in the treatment of skin, soft tissue and deep structure defect of the upper extremities in 20 patients. Soft tissue expander was first implanted to provide sufficient soft tissue for skin coverage. In the procedure of expender removal and skin coverage, the deep structures were reconstructed simultaneously. The reconstructive procedures included tenolysis, tendon transfer or grafting, neurolysis and/or nerve grafting, and joint release etc. Results The patients were followed at 6 months postoperatively. The quality, color and consistency of skin and soft tissue which was reconstructed was close to normal skin. The overall excellent and good rate of joint movement was 87.5 % after tenolysis (TAM standard). Conclusions Traditionally, reconstruction of post traumatic skin, soft tissue and deep structure defect was carried out in two stages. Application of soft tissue expansion possesses such advantages as shortening of treatment course, providing soft tissue for wound coverage, and one stage reconstruction of the deep structures.