大张全厚皮取皮术中应用肿胀技术意义及机理分析.doc

大张全厚皮取皮术中应用肿胀技术意义及机理分析【摘要】目的:介绍一种实用的大张全厚皮取皮术式。方法 对32例预取大张全厚皮部位,应用肿胀技术,皮下注射肿胀液,于真皮下切取全厚皮片。结果:32例大张全厚皮取皮术部位,失血量极小,术野清晰, 能切取任意形状且仅附菲薄皮下组织的全厚皮片,供皮创面无明显凹陷和放大。.结论:肿胀技术对大张全厚取皮术有实用价值。? 【关键词】肿胀技术;全厚皮片;整形手术? 【中图分类号】R622 【文献标识码】A 【文章编号】1008-6455(2010)07-0030-02 The significance and mechanism of tumescent technique for takinglarge full-thickness skin graftsWang Yuyin He Jiyong Liu Xiaoping et al.? 【Abstract】Objective:Introduce a pragmatic method for taking large full-thickness skin grafts . Methods:In each of the 32 cases , whichlarge-piece and full-thickness skin grafts were to be taken from, tumescent solution was injected in shallow subcutis of skin donor area , then large-piece and full-thickness skin graft was sheared from the shallow subcutis. Results:In every operation in the 32 cases for taking large full-thickness skin grafts , little bloodwas losed ,local operative areawas clear , large full-thickness skin graft area was scarcely affiliated by subcutis and the wound area was not obviously depressed or enlarged . Conclusion:The application of tumescent technique for taking large-piece and full-thickness skin grafts is valuable.? 【Key words】Tumescent technique; Full-thickness skin graft ; Plastic operation 整形美容手术中,不乏需取整大张全厚皮移植。尽管偏小的全厚皮片取皮后供区可直接拉拢缝合,但未经扩张的供皮处在大张全厚皮供皮后,创面缝合张力大或不能缝合;而且即便用鼓式取皮机或电(气)动取皮机,也很难把握全厚皮层次、大小及形状。我们将Klein发明的肿胀技术[1]应用于大张全厚取皮术,可取得一般取皮术不具备的优势。? 1 技术方法? 1.1 肿胀液的基本配方:300ml生理盐水+1ml(1mg)肾上腺素。? 1.2 预取全厚皮部位选择:术者根据患者全身体表情况、受皮部位及患者和家属要求等因素选择。尽量选用较隐蔽、非功能、术后可行弹力加压部位,如(例图)大腿中上段。避开增生孪缩瘢痕,对大面积烧伤后患者,可取浅二度烧伤或已取刃厚皮愈合后有色素沉着皮肤。? 1.3 切取全厚皮手术方法:对需植全厚皮的创面,在面积和形状不需改变后,以无菌模纸(布)印样,置于预取全厚皮部位的表面,根据局部皮肤弹性等特性适当放样,甲紫蓝画出预取全厚皮外周轮廓线,在所画线内及线外缘皮下注射肿胀液。注射层次为真皮下、浅筋膜层,皮下深层不必注射,避免皮内注射。注射量以皮肤轻度至中度肿胀、稍发白、略变硬为宜。于画线切开全层皮肤,选择术者便于操作部位缝皮肤牵引线,刀片于真皮下切剥离全层皮肤,同时以纱布拭吸肿胀液和散在的血迹,留稀疏的白色纤维网状样结构和细颗粒脂肪组织面,尽量不使粗颗粒脂肪层裸露, 并避免刀片在真皮深面划出深痕。? 1.4 全厚皮供皮创面的修复:以断层皮片移植。可在头部发际区内注射肿胀液后以小滚轴刀切取,对头部刃厚皮不足或不同意取者,另以电(气)动取皮刀取其它部位刃厚皮或中厚皮。尽量用大片状刃厚皮,移植皮片间不留间隙,并稍超出受皮创面外周缘,加压包扎。若全厚皮供皮创面于腹前壁、背部,创面外周需