应用不同皮瓣修复手掌重度瘢痕挛缩畸形的临床分析

发布时间：2018-06-14 21:45

本文选题：瘢痕挛缩 + 软组织缺损　；参考：《中国修复重建外科杂志》2016年03期

【摘要】：目的探讨应用不同皮瓣修复手掌重度瘢痕挛缩畸形的疗效。方法 2013年2月-2015年3月,收治手掌重度瘢痕挛缩畸形13例。其中男10例,女3例;年龄14~54岁,平均39岁。致伤原因:火焰烧伤、烫伤9例,热压伤2例,化学烧伤1例,电击伤1例。伤后至手术时间为6个月~6年,平均2.3年。术中充分切除、松解挛缩瘢痕及粘连的深部组织,恢复各指至伸直位,软组织缺损范围为6.0 cm×4.5 cm~17.0 cm×7.5 cm。采用桡动脉逆行岛状皮瓣(2例)、腹部带蒂皮瓣(4例)、游离胸背动脉穿支皮瓣(2例)、游离股前外侧皮瓣(1例)、游离肩胛皮瓣(4例)修复创面;皮瓣切取范围6.0 cm×4.5 cm~17.0 cm×7.5 cm。结果术后皮瓣全部成活。1例腹部带蒂皮瓣出现远端血运障碍,远端创面经换药后延迟愈合;其余患者创面均Ⅰ期愈合;供区植皮成活,切口均Ⅰ期愈合。13例患者均获随访,随访时间6~14个月,平均8个月。8例患者接受1~3次皮瓣修薄术。末次随访时患者手部功能均明显改善,外观满意。结论选用合适的皮瓣修复手掌重度瘢痕挛缩畸形能获得较好的治疗效果。
[Abstract]:Objective to investigate the effect of different flaps on the repair of severe scar contracture deformity of the palm. Methods from February 2013 to March 2015, 13 cases of severe cicatricial contracture deformity of palm were treated. Among them, 10 cases were male and 3 cases were female, the age was 14 ~ 54 years old with an average age of 39 years. The causes of injury were flame burn, burn in 9 cases, hot pressure injury in 2 cases, chemical burn in 1 case, electric injury in 1 case. The time from injury to operation was from 6 months to 6 years, with an average of 2.3 years. The deep tissues of contracture scar and adhesion were fully resected during operation, and the soft tissue defect was 6. 0 cm 脳 4. 5 cm~17.0 cm 脳 7. 5 cm 路cm. The wound was repaired by radial artery retrograde island flap (n = 2), abdominal pedicle flap (n = 4), perforator flap of dorsal thoracic artery (n = 2), free anterolateral femoral flap (n = 1) and free scapular flap (n = 4). Results all the flap survived. 1 cases of abdominal pedicled skin flap developed distal blood flow disturbance and delayed healing of distal wound after dressing change. All the other patients healed in first stage, donor skin graft survived, and 13 cases were followed up. The follow-up time was 6 ~ 14 months (average 8 months). At the last follow-up, the hand function was improved obviously and the appearance was satisfactory. Conclusion suitable skin flap can be used to repair severe scar contracture deformity of palm.
【作者单位】：四川大学华西医院烧伤整形科;
【分类号】：R658.2

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