负压吸引联合软组织扩张术修复头皮缺损临床应用分析.docVIP

负压吸引联合软组织扩张术修复头皮缺损临床应用分析 　　[摘要]目的：探讨负压吸引联合软组织扩张术在治疗头皮缺损中的临床疗效。方法：自2008年始，笔者采用负压吸引联合软组织扩张术治疗各种类型头皮缺损30例（男性22例，女性8例，年龄5～58岁），头皮缺损区先安装负压吸引装置（VSD）行负压吸引，创面肉芽组织生长良好后游离皮片移植。创面愈合后，根据头皮瘢痕的情况设计软组织扩张器的大小、形状和置入位置，II期以旋转、推进等方式转移扩张皮瓣以修复原头皮缺损区。结果：本组患者经负压吸引、游离植皮及软组织扩张，均成功修复头皮缺损，疗效满意。共使用46个软组织扩张器，其中最大修复面积约10cm×12cm，均未出现严重并发症。结论：负压吸引联合软组织扩张术修复头皮缺损是一种简单、有效的治疗方案。 中国论文网 /6/view-7244988.htm 　　[关键词]负压吸引；软组织扩张术；头皮缺损；联合应用；游离植皮 　　[中图分类号]R622 [文献标志码]A [文章编号]1008-6455（2015）21-0005-03 　　Abstract： Objective To discuss the surgical methods and clinical efficacy of tissue expander and vacuum sealing drainage（VSD）in repairing of the scalp defects. Methods 30 cases with scalp defects were repaired with tissue expanders and VSD since 2008（22 males and 8 females，aged 5-58 years old）.All cases were treated by VSD before skin grafting.After the wounds closed up，then designed the size，shape and embedded way of the expander according to the location of scalp cicatrices，expanded the flap regularly，and transferred the expanded flaps through rotation，advancement or axial flap to repair the cicatrices in a second stage surgery. Results All flaps were survived well and the results were satisfactory.46 expanders were used in the 30 cases.All the cases were treated without serious complications.The largest area of repaired cicatrix was 10cm×12cm. Conclusion Continuous VSD combined with tissue expander technology has proven its simpleness and efficiency in treatment of scalp defects before and after skin grafting，reducing costs and duration of treatment. 　　Key words：vacuum sealing drainage（VSD）；soft tissue expansion；scalp defects；combined application；free skin graft 　　随着人们对外活动的日益频繁，外伤致头皮缺损的患者也越来越多，面积较小的头皮缺损可以通过简单的皮下组织游离而闭合创面，较大的头皮缺损则需要更复杂的重建方式，难度较大。笔者对所在医院烧伤整形外科2008年以来收治的30例头部皮肤软组织缺损患者采用负压吸引（VSD）联合软组织扩张术治疗，均取得满意疗效，现报道如下。 　　1 资料和方法 　　1.1 临床资料 　　本组共30例，男22例，女8例；年龄5～58岁；致伤原因：烧伤（高压电、火焰、浓硫酸）19例，机器致头皮撕脱伤3例，车祸伤8例。头部软组织缺损面积6cm×9cm～10cm×12cm，平均6.5cm×10.3cm，其中伴颅骨外露9例。 　　1.2 手术方法 　　1.2.1 创面清创负压吸引：对于坏死的组织、异常分泌物以及痂皮