扩张器重叠扩张技术在临床中应用.docVIP

扩张器重叠扩张技术在临床中应用[摘要]目的:探讨提高皮肤软组织扩张器扩张效果的有效方法。方法:在同一腔隙内埋置两个大小不同的扩张器,对重叠放置的扩张器按照先浅后深的顺序逐步扩张至额定容积的1.5倍。结果:自2003年1月以来,采用重叠扩张术修复各种类型的皮肤软组织缺损36例,均获得良好的手术效果。结论:与传统组织扩张技术相比,重叠扩张技术在同等剥离腔隙、同等时间内可以获得更多地有效扩张面积,同时可以减少扩张术的并发症。 [关键词]组织扩张术;重叠扩张;组织缺损;扩张器 [中图分类号]R622 [文献标识码]A [文章编号]1008-6455(2010)03-0310-02 The clinical application of overlapping tissue expansion techniques CHU Guo-hua1, QIU Shu-lin2, YAN Yan3, YAO Jin-ying1, GONG Xiang-sheng1 (1.Department of Cosmetic Surgery,Cangzhou traditional Chinese and Western hospital,Cangzhou,061000,Hebei,China; 2.Department of Plastic Surgery,Hebei Provincial People’s Hospital;3.Beijing Electric Hospital) Abstract:ObjectiveTo discuss the effective ways to improve the effect of soft tissue expander.MethodsTwo expanders of different sizes were buried in the same soft tissue pocket. The overlapped expanders are put, in the sequence from the shallowness to the deepness, to expand gradually to the 1.5 times of given capacity.ResultsSince January of 2003, by using the overlapping expansion technique to repair skin defects, 36 cases of different kinds of skin defects had obtained better operation effects.ConclusionsCompared with the traditional expansion techniques, the overlapping expansion technique can get more effective areas in the same situations. Besides, it can reduce the complications of tissue expansion. Key words: tissue expansion; overlapping tissue expansion ; tissue defects; expander 皮肤软组织扩张技术经过多年来的基础和临床研究,目前已经成为整形外科修复组织缺损畸形和器官再造的常用有效方法。笔者自2005年3月以来应用重叠扩张技术修复各种类型的皮肤软组织缺损36例均获得了满意疗效。 1临床资料 1.1 本组36例,男23例,女13例,年龄15～33岁,平均年龄24岁,其中头面部巨大神经纤维瘤7例,面颈部瘢痕挛缩畸形17例,胸背部瘢痕畸形4例,下肢皮肤缺损1例,躯干部巨痣3例,面部血管瘤3例,面颈部巨痣5例。修复的面积范围150～330cm2,扩张器数量2～6个,注水量750～2 230ml。 1.2 典型病例:患者男,32岁,因头部巨大神经纤维瘤来我院就诊(图1～3),肿瘤范围前起于左上眼睑,后至顶枕部,大小为19cm×11cm。于全麻下在肿瘤周围重叠埋置三组共5个扩张器,其中两组容积分别为500ml和250ml,一组扩张器容积为200ml和100ml。术后7天伤口愈合开始注入扩张溶液,注水至扩张器额定容积的约1.5倍(图4～6),注水结束2周后行神经纤维瘤切除扩张器取出皮瓣转移整形修复术,术后随访1.5年,效果满意(图7～9)。 2手术方法 选择病变区附近头发茂密部位为置入部位,皮肤切口位于日后将形成皮瓣的