阴茎毁损性烧伤的修复与重建

目的 总结毁损性深度烧伤所致阴茎缺损的修复和重建经验. 方法 对24例烧伤后早期或晚期(指创面愈合半年后.下同)阴茎长度缺失患者行修复手术.术中切断阴茎悬韧带,使缺损阴茎残端向前延伸以获得足够长度,分别用下腹壁皮瓣、阴囊皮瓣或阴股沟皮瓣修复阴茎延长后创面.其中10例患者于伤后30 d内手术,14例于晚期手术.观察患者术后皮瓣成活及并发症发生情况;于手术前及治愈后随访时,测量患者常态下及勃起状态下阴茎的长度;随访了解患者阴茎皮肤感觉功能恢复情况、阴茎勃起功能及性生活满意度. 结果 24例患者中,2例术后皮瓣远端分别出现1.0 cm×0.5 cm和1.5 cm × 1.0 cm部分坏死,经换药后愈合,其余皮瓣均完全成活.所有患者随访2～5年,常态F阴茎长度为(7.4±1.6)cm,较术前延长(5.3±1.4)cm(P<0.01);勃起时长度达(9.7±1.2)cm.阴茎感觉均在术后半年左右逐步恢复,勃起功能良好.除1例未再尝试性生活外,其余已婚患者及其配偶均感性生活满意或基本满意. 结论 对毁损性烧伤所致阴茎缺损,采用阴茎延长结合皮瓣移植,可保留阴茎的适当长度和性功能,是较好的治疗方法 .

Repair and reconstruction of penile defects due to devastating deep burn

Objective To summarize the experience of repair and reconstruction of penile defects as a result of devastating deep burn. Methods Twenty-four patients with penile defects in early or late(a half year after wound healed,the same below)stage after burn were involved.Their suspensory ligaments of penis were dissected to lengthen the penis after escharotomy with the necrotic distal part removed.The wounds formed after lengthening were covered with lower abdominal skin flap,scrotal or internal pudendal artery flap.Ten patients underwent surgery within 30 days after burn;the other 14 patients underwent sur-gery in the late stage.The condition of flaps and complications after surgery were observed.The lengths of penis of patients in flaccid and erection state were measured before surgery and at follow-up period.The sen-sory function of penile skin,the erectile function of the penis,and sexual intercourse activity of patients were foIlowed up. Results All the flaps survived except two.in whom areas of 1.0 cm × 0.5 cm and 1.5 cm×1.0 cm of necrosis at distal parts were found, and they healed after dressing changes.Patients were followed up for 2 to 5 years.The length of penis in flaccid state was(7.4±1.6)cm,which was(5.3±1.4)cm lon-ger than that before surgery(P<0.01).The length of penis in erection state was(9.7±1.2)cm.The sensory function of penises recovered gradually about half year after surgery with well preserved erectile func-tion.Except one who did not try to have sexual intercourse again.all the other married patients and their spouses were satisfied or quite satisfied with sexual intercourse activity. Conclusions Penis elongation combined with skin flap grafting is a good method for the treatment of penile defects due to devastating deep burn.Suitable length and erectile function of penis can be preserved with this method.