论文部分内容阅读
目的 探讨应用扩张器预制扩张髂腹股沟超薄皮瓣二期带蒂治疗手及前臂瘢痕的体会.方法 2003年1月至2012年1月我院收治16例手、前臂瘢痕患者,其中伴有腕关节或掌指关节挛缩畸形12例,均采用扩张器扩张预制髂腹股沟超薄皮瓣修复,一期髂腹股沟皮瓣下安置扩张器,定期注射生理盐水扩张皮瓣,3～6个月行二期手术,取出扩张器,同时切取带蒂髂腹股沟超薄皮瓣,转移覆盖手或前臂瘢痕切除后创面,取瓣供区直接缝合,3～4周予皮瓣断蒂,拆线后逐渐加强手功能锻炼.结果 扩张器植入术后无一例发生感染、血肿、外露等并发症,注射生理盐水扩张成功,均将皮瓣扩张至所需要的面积.二期切取超薄髂腹股沟皮瓣修复创面,有2例皮瓣远端宽约1 cm边缘坏死,经换药后创面愈合,其余14例皮瓣均存活.随访6～ 18个月,皮瓣质地良好,不臃肿,外观满意,不需再次行皮瓣修薄整形术,手、腕关节功能恢复满意.结论 应用扩张器扩张髂腹股沟超薄皮瓣治疗手、前臂瘢痕可最大限度地恢复手、前臂外观以及功能,是治疗手、前臂瘢痕的良好手术方式之一.“,”Objective To introduce the experiences of using tissue expander to prefabricate ultra-thin groin flap for secondary wound coverage after scar excision of the hand and forearm.Methods From January 2003 to Janumy 2012,16 cases of hand and forearm scars were treated in our hospital.Wrist or metacarpophalangeal joint contracture deformity existed in 12 cases.All were treated with ultra-thin groin flaps.A tissue expander was placed undemeath the groin flap.Saline was injected into the expander on a regular basis to stretch the flap.A second surgery was done 3 to 6 months later to remove the expander and transfer the pedicled ultra-thin groin flap to cover the hand or forearm scar excision wounds.The flap donor site was closed directly.The pedicle was severed 3 to 4 weeks later.Escalated exercises of the hand resumed after suture removal.Results There were no infection,hematoma or device exposure after tissue expander implantation.Injection of saline into the expander successfully expanded the groin flaps to the desired sizes.After secondary groin flap transfer distal necrosis of a strip of 1 cm at the edge of the flap occurred in 2 cases.Debridement and dressing change healed the wound.The remaining 14 flaps survived uneventfully.6 to 18 months follow-up revealed good texture and satisfactory appearance of the flaps.There was no bulkiness of the flap that requires debulking surgery.Functions of the hand and wrist were satisfactory.Conclusion Ultra-thin groin flap created by tissue expander application is a good treatment option for hand and forearm scars.Wound coverage after scar excision with this flap maximizes recovery of hand and forearm aesthetics and function.