手腕及前臂远端扩张皮瓣治疗手背皮片移植术后瘢痕.docVIP

手腕及前臂远端扩张皮瓣治疗手背皮片移植术后瘢痕[摘要]目的：评价应用腕部及前臂远端扩张皮瓣治疗手背皮片移植术后瘢痕及瘢痕所引起的功能障碍的治疗效果。方法：本组共治疗8例患者、13只手。一期于手腕及前臂背部植入扩张器，术后常规注水，注水效果满意后，行二期手术治疗。二期手术切除手背瘢痕、充分松解挛缩，矫正畸形，扩张皮瓣覆盖创面。结果：术后随访3～6个月，皮瓣全部成活，手部外观及功能恢复满意。结论：手腕及前臂背部扩张皮瓣修复手背部植皮术后瘢痕治疗效果肯定。 [关键词]组织扩张；手背；瘢痕；皮片移植 [中图分类号]R622[文献标识码]A[文章编号]1008-6455（2008）03-03 Therapy for free skin graftings’ scar of dorsum manus using expanded flaps of wrist and forearm’s distal end ZHANG Yi, CHEN Guang-yu, CAI Guo-bin, LI Hai-dong, LIU Liu, WANG Lian-zhao, LI Tai-ying (Plastic Surgery Hospital of Chinese Academy of Medical Science, Beijing 100047, China) Abstract：ObjectiveTo evaluate the therapy for free skin graftings’ scars and dysfunctions of the dorsum manus using expanded flaps of wrist and forearm’s distal end.Methods8 patients，13 hands were therapied by using expanded flaps of wrist and forearm’s distal. Tissue expanders were implanted in the first stage. Then infuse saline into expanders. Second operation was done when expansion effect was satisfactory. Excise all the scars in dorsum of hand, rectify contracted deformations thoroughly, cover raw surface using expanded flaps in the second operation finally.Resultsall cases had been followed up for 3~6 months since the second operation, all flaps survived, external appearance and function of all hands’ dorsa were satisfactory.ConclusionIt was confirmed that the effect of using expanded flaps of wrist and forearm’s distal end to therapy free skin graftings’ scars in the dorsum of hand. Key words: tissue expansion; dorsum of hand; scars; skin grafting 手背部皮肤较薄，且皮下组织少，仅有薄薄的一层疏松结缔组织将皮肤与肌腱、关节囊、韧带隔开，故手背的烧伤极容易造成严重的拇指及其余各指内收畸形和各指掌指关节的背伸畸形。在手背部烧伤的治疗中，患者多于烧伤后2～5天行削痂植皮术，术后患者基本能最大程度上保留手部功能[1]。但是，皮片移植术不能满足手背形态功能修复的所有需要，移植皮片挛缩造成的虎口及各个指蹼再次发生挛缩畸形，各指掌指关节背伸畸形，以及移植后皮片与肌腱等深层组织粘连等局限，大大影响了手部功能及外形的进一步恢复；且皮片色素沉着、脱失及皮片周缘的切口瘢痕严重影响了手部外观，因此众多患者要求进一步治疗。现应用手腕背部扩张皮瓣的方法治疗8例患者，共13只手，效果满意。 1资料和方法 1.1一般资料：本组病例8例，13只手（左8右5）。患者均为女性，年龄15～34岁。致伤原因为火焰烧伤及热液烫伤。本组患者均在伤后5天内行手背削痂植皮术。患者手部功能大部分保持良好，指间关节无明显僵硬；