皮下组织蒂菱形皮瓣成形术治疗烧伤后疤痕挛缩

目的介绍皮下组织蒂菱形皮瓣成形术治疗烧伤后疤痕挛缩的应用经验。方法以疤痕挛缩张力线为长轴线设计菱形皮瓣,长轴顶点为约60°皮瓣锐角,菱形皮瓣的短轴顶点为约120°的钝角,切开菱形四边形成垂直皮下组织蒂,适当剥离菱形皮瓣短轴外的皮下组织,沿短轴方向向皮瓣外作延长切口。将两锐角的V切口作Y形延长后缝合,两钝角的Y切口作V形推进缝合,必要时采用两个及两个以上串联菱形瓣。结果 67例93个菱形瓣均良好成活,手术后疤痕挛缩线获得60%~250%的延长,平均延长80%。术后随访6个月至2年,未见疤痕挛缩再发。结论皮下组织蒂菱形皮瓣设计简单,血供可靠,手术操作简单易行,效果确切,并发症少,适用于跨关节挛缩瘢痕畸形,在多数情况下可替代传统Z成形及W成形手术。

Subcutaneous pedicle rhomboid flap plasty for the treatment of postburn scar contractures

Objective To introduce the method of subcutaneous pedicle rhomboid flap plasty for the treatment of postburn scar contractures. Methods Incisions were designed in a rhomboid shape over the contracture. Wide angles were localized laterally to scar contracture and the narrow angles proximally and distally. The lengths of incisions of rhomboid flap were equal to each other, and additional incisions were used transversely beginning from the outer edge of wide angles in the fashion ＂cut as you go＂, fibrotic bands leading to contracture were released. The tissue outside and around the rhomboid flap could be undermined appropriately in order to decrease the suture’s tension, whereas the tissue inside the rhomboid flap forbade undermining. After scar contracture were incised and released, lateral corners were advanced laterally to the end of the additional incisions, proximal and distal corners were sutured primarily with approximation of incisions. By doing this, the V-shaped incision was transformed into a Y-shaped wound closure, and the Y-shaped incision into V-shaped wound closure. No free skin grafts were done. Sometimes, two or more rhomboid flaps in tandem were necessary depending on the degree of scar contractures. Results Sixty-seven cases with 93 rhomboid flaps healed uneventfully. The gain in length provided by a single rhomboid flap ranged from 60% to 250%,80% on average. Six months to 2 years postoperatively, follow-up results indicated no scar contracture recurrence. Conclusion The subcutaneous pedicel rhomboid flap plasty is easy to use, has rich vascularity and mobility. It is effective and might be on alternative to the current techniques, such as Z-plasty series and V-Y-plasty series, in surgical treatment of mild to moderate postburn scar contractures.