预扩张腹部轴型皮瓣在上肢大面积瘢痕修复中的应用(1)
[摘要] 目的 探讨预扩张腹部轴型皮瓣修复上肢大面积瘢痕的方法及疗效。 方法 手术分3期进行，第1期根据上肢瘢痕部位及面积，选择旋髂浅动脉、腹壁浅动脉、腹壁下动脉的脐旁穿支、肋间后动脉外侧穿支中的一组腹部轴型皮瓣预先扩张；经过3～4个月的注水扩张后行第2期手术，将预扩张的腹部轴型皮瓣以带蒂转移的方式修复上肢瘢痕切除后的皮肤缺损；3周后再行第3期手术，即皮瓣断蒂。 结果 本组12例患者应用预扩张腹部轴型皮瓣15例，其中3例患者应用双侧预扩张腹部轴型皮瓣，皮瓣全部存活，外形不臃肿，颜色、质地与周围皮肤接近，患肢功能明显改善。 结论 预扩张腹部轴型皮瓣是修复上肢大面积瘢痕的一种非常有效的方法，能取得外形及功能均为满意的结果；但治疗周期长，需分次手术为其缺点。
[关键词] 预扩张皮瓣；瘢痕；修复；腹部轴型
[中图分类号] R62 [文献标识码] A [文章编号] 1674-4721(2012)06(a)-0026-02
, 百拇医药
The application of expansion of upper abdomen shaft flap in the large area of the scar tissue
ZHAO Jun1 CHEN Haisheng1 ZENG Xinming1 XIE Jianhuan1 LIU Xiaorong2▲
1.Department of Hand Surgery, People′s Hospital of Dongguan City in Guangdong Province, Dongguan 523000, China; 2.Department of Cosmetic and Plastic Surgery, People′s Hospital of Dongguan City in Guangdong Province, Dongguan 523000, China
, http://www.100md.com
[Abstract] Objective To investigate the methods and effects of reconstruction of the upper extremity with large-sized scar using the preexpanded abdominal-based axial flap. Methods The operation was performed in three stages. At the first stage, one of the four flaps, namely, the superficial circumflex iliac artery flap, the superficial inferior epigastric artery flap, the paraumbilical perforator of the deep epigastric artery flap, or the lateral intercostal artery perforator flap was chosen and preexpanded, according to the size and the location of the scar in the upper extremity. At the second stage, after adequate expansion lasting 3 to 4 months, the preexpanded flap was pedicled and transferred to resurface the upper extremity after scar resection. At the last stage, 3 weeks later, the pedicle was divided. Results The 12 patients application expansion shaft gets abdominal type flap in 15 cases, 3 patients with bilateral the application expansion shaft type abdominal skin flap, flap all survived, not bloated shape, color, texture and surrounding skin close, limb function improved obviously. Conclusion The expansion of abdominal shaft flap is large area of the upper scar tissue repair a very effective method, can obtain appearance and function are the satisfied result; But the treatment cycle is long, the need for the first operation points shortcomings.
[Key words] Preexpanded flap; Scar; Reconstruction; Abdominal shaft type
上肢烧伤、电击伤、碾压伤后易形成大面积瘢痕，关节部位瘢痕常致关节挛缩，严重影响外形及功能。目前上肢大面积瘢痕的修复方法主要有游离植皮、邻近皮瓣带蒂转移、远位皮瓣带蒂转移及游离皮瓣移植等，但修复效果均难以令人满意。2009年1月～2011年12月，笔者根据上肢瘢痕病变情况，选择预扩张腹部轴型皮瓣以带蒂转移的方式修复瘢痕切除后上肢皮肤缺损患者12例，其中3例患者为双上肢瘢痕应用双侧预扩张腹部轴型皮瓣修复，取得满意的效果。, http://www.100md.com(赵军 陈海生 曾昕明 谢见欢 刘小容)
[关键词] 预扩张皮瓣；瘢痕；修复；腹部轴型
[中图分类号] R62 [文献标识码] A [文章编号] 1674-4721(2012)06(a)-0026-02
, 百拇医药
The application of expansion of upper abdomen shaft flap in the large area of the scar tissue
ZHAO Jun1 CHEN Haisheng1 ZENG Xinming1 XIE Jianhuan1 LIU Xiaorong2▲
1.Department of Hand Surgery, People′s Hospital of Dongguan City in Guangdong Province, Dongguan 523000, China; 2.Department of Cosmetic and Plastic Surgery, People′s Hospital of Dongguan City in Guangdong Province, Dongguan 523000, China
, http://www.100md.com
[Abstract] Objective To investigate the methods and effects of reconstruction of the upper extremity with large-sized scar using the preexpanded abdominal-based axial flap. Methods The operation was performed in three stages. At the first stage, one of the four flaps, namely, the superficial circumflex iliac artery flap, the superficial inferior epigastric artery flap, the paraumbilical perforator of the deep epigastric artery flap, or the lateral intercostal artery perforator flap was chosen and preexpanded, according to the size and the location of the scar in the upper extremity. At the second stage, after adequate expansion lasting 3 to 4 months, the preexpanded flap was pedicled and transferred to resurface the upper extremity after scar resection. At the last stage, 3 weeks later, the pedicle was divided. Results The 12 patients application expansion shaft gets abdominal type flap in 15 cases, 3 patients with bilateral the application expansion shaft type abdominal skin flap, flap all survived, not bloated shape, color, texture and surrounding skin close, limb function improved obviously. Conclusion The expansion of abdominal shaft flap is large area of the upper scar tissue repair a very effective method, can obtain appearance and function are the satisfied result; But the treatment cycle is long, the need for the first operation points shortcomings.
[Key words] Preexpanded flap; Scar; Reconstruction; Abdominal shaft type
上肢烧伤、电击伤、碾压伤后易形成大面积瘢痕，关节部位瘢痕常致关节挛缩，严重影响外形及功能。目前上肢大面积瘢痕的修复方法主要有游离植皮、邻近皮瓣带蒂转移、远位皮瓣带蒂转移及游离皮瓣移植等，但修复效果均难以令人满意。2009年1月～2011年12月，笔者根据上肢瘢痕病变情况，选择预扩张腹部轴型皮瓣以带蒂转移的方式修复瘢痕切除后上肢皮肤缺损患者12例，其中3例患者为双上肢瘢痕应用双侧预扩张腹部轴型皮瓣修复，取得满意的效果。, http://www.100md.com(赵军 陈海生 曾昕明 谢见欢 刘小容)