瘢痕内松解治疗颈部瘢痕挛缩.doc

瘢痕内松解治疗颈部瘢痕挛缩[摘要]目的：探讨瘢痕内松解治疗颈部瘢痕挛缩的可行性。方法：从2005年3月到2008年11月，应用自制的推刀对收治的6例Ⅱ度颈部瘢痕挛缩畸形的患者行瘢痕内切开，松解挛缩，术后应用颈部弹力套压迫防止瘢痕增生、继发挛缩。结果：头颈部活动度6例中4例明显改善，2例好转。平均随诊 8个月(3～20个月)未见挛缩复发。颌颈部曲线自然，颏颈角清晰。结论：瘢痕内松解可增加瘢痕挛缩畸形颈部的活动度。对于轻度颈部瘢痕挛缩可改善外观和功能, 患者满意率高。 [关键词]颈部瘢痕挛缩；瘢痕内松解；瘢痕 [中图分类号]R622 [文献标识码]A [文章编号]1008-6455（2009）01-0010-03 Release within scar for treatment of scar contracture of the neck CHEN Bin，LI Sen-kai，LI Yang-qun，LI Qiang，DUAN Chen-wang， HUANG Xun-lei （The Second Plastic Surgery Department， Plastic Surgery Hospital, Chinese Academy of Medical Science Peking Union Medical College,Beijing 100144，China） Abstract:ObjectiveTo investigate the feasibility of the treatment of scar contracture of the neck by release within scar using a modified scalpel.MethodsBetween March 2007 and November 2008, 6 patients with type Ⅱ scar contracture of the neck underwent the procedure of release within scar using a tailor-made scalpel. Postoperatively, an elastic cuff was used to cover the neck to matain a persistent pressure on the surface of the scar for more than six monthes to prevent scar hyperplasia and secondary contracture.ResultsPostopratively, the movement of the neck was improved significantly in 4 cases and moderately in the other 2 patients. Within 8-month (3 to 20 months) follow-up, there was no contracture recurred.All patients kept a natural cervical curve and a clear mandible-cervical angle. ConclusionsRelease within scar could improve the movement of the scar contracted neck. If patients selected appropriately, a good result and higher satisfactory rate could be achieved. Key words: scar contracture of the neck; release within scar; scar 颈部是烧伤瘢痕最常发生的部位之一，外露的瘢痕和继发的挛缩严重影响颈部功能和外观。治疗的方法主要有Z字成形，中厚或全厚皮片移植，局部皮瓣转移, 游离皮瓣移植，扩张皮瓣转移等。这些方法各有优缺点，没有一种方法能够在功能和外观上同时达到一个很理想的效果，并且可能对供区造成一定损害。近年来，我们应用自制的推刀对烧伤后轻度颈部瘢痕挛缩的患者进行瘢痕内松解，保留原瘢痕皮肤的同时可明显增加颈部活动度，外观功能上令患者满意。 1临床资料 1.1 一般资料：6例患者，女5例，男1例，16～25岁，平均20岁，汽油火焰烧伤1例，开水烫伤5例。烧伤急诊创面处理愈合后平均15年（12～21年），其中1例行扩张皮瓣转移术后5年。瘢痕稳定呈片状，索条状，质