胸三角皮瓣预扩张术后防止扩张囊移位方法探析.docVIP

胸三角皮瓣预扩张术后防止扩张囊移位方法探析[摘要]目的:探讨如何有效预防胸三角皮瓣预扩张术后扩张囊移位。方法:本组患者60例,均行胸三角皮瓣预扩张术,术前设计选用合适大小的扩张器,术中注意剥离层次及范围,止血彻底,术后早期注水、适当固定。结果:60例中扩张器均扩张良好,2例出现血肿,3例注射壶外露,经及时处理后均能继续扩张,无一例出现扩张器移位,皮瓣转移后血运良好,面颈部瘢痕修复效果理想。结论:采用术前、术中、术后的综合措施预防胸三角皮瓣预扩张时扩张器下沉移位效果显著,能基本解决扩张囊移位,为二期手术打下良好的基础。 [关键词]胸三角皮瓣;扩张术;移位 [中图分类号]R622[文献标识码]A[文章编号]1008-6455(2010)01-0020-03 The methods to prevent the expander shifting after operation of deltopectoral flap predilatation LI Xian-hui,WANG Lu,JIAN Cai,MA Xian-jie (Institute of Plastic Surgery of People’s Liberation Army,Xijing Hospitol,the Fourth Military Medical University,Xi’an 710032,Shaanxi,China) Abstract:ObjectiveTo explore how to prevent the expander shifting after operation of deltopectoral flap predilatation.Methods60 suitable cases were included in the study. Deltopectoral flaps predilatation was performed to treat these patients with suitable volume expanders, which also was needed to pay more attentions to sufficient hemostasis and disjuncting layer during the operation as well as early water flooding and appropriate immobilization after operation. Resultsall of 60 cases were well ectasised with complications of hematoma for 2 cases and syringe valve outerop for 3cases. After being corrected in time,all the cases were satisfactoried with the flaps well survival and faciocervical scars effectively repair after skin flaps transpositioned.ConclusionThe combination of preoperative,intraoperative and postoperative intervention can effectively prevent the expander shifting after deltopectoral flap predilatation,which can be the better preparation for the second stage operation. Key words:deltopectoral flap; dilatation; shifting 1976年Radovan发明可控式扩张器以来,皮肤软组织扩张术已被广泛应用于临床,获得了较好的疗效[1]。而应用扩张后的胸三角皮瓣( deltopectoral flap)修复面颌颈部瘢痕及缺损也取得了满意的效果[2-4]。但由于胸前区深筋膜组织疏松,肩部致密,加上扩张器注水后重力作用,故扩张器常向内下移位,使转移后的胸三角皮瓣长度不够,造成修复困难,影响二期手术效果。下面笔者就防止胸三角皮瓣预扩张术后扩张器移位的经验予以探讨总结。 1临床资料 本组患者60例,年龄9～37岁,均为2008年来我科就诊的烧伤后面颈部瘢痕患者,其中单侧42例(左侧19例,右侧23例),双侧18例,男性48例,女性12例。扩张器