多个大容量扩张器在治疗头部巨大瘢痕性秃发中应用.docVIP

多个大容量扩张器在治疗头部巨大瘢痕性秃发中应用 　 作者：张新合，杨新蕾，郭志谦，江碧川 【摘要】 目的 探讨多个大容量扩张器在治疗头部巨大瘢痕性秃发中的应用价值。方法 回顾分析我科2003年以来应用多个大容量扩张器治疗16例头部巨大瘢痕性秃发患者的临床资料。计算瘢痕面积及所需扩张的容量，选择300~600 ml 扩张器，一期手术置入瘢痕区域周围正常皮下，扩张满意后2~4周取出扩张器、切除瘢痕、局部推进、旋转或轴型皮瓣修复创面。结果 16例患者共治疗21处瘢痕，置入扩张器35个。修复面积最大14 cm×16 cm，所有患者均得到有效治疗；4处术后并发血肿，其中1例切口愈合不良扩张器外露。结论 多个大容量扩张器在治疗头部巨大瘢痕性秃发中效果显著。 【关键词】 扩张器；皮肤扩张术；瘢痕性秃发；皮瓣 Abstract： Objective To study the clinical application of multiple skin expander to the treatment of cicatricial calvities.Methods Sixteen patients with cicatricial calvities treated by multiple skin expanders in our department since 2003 were reviewed retrospectively. We calculated the expanded volum and selected 300-600 ml expanders which were put under the aponeurotica gales nearby the scars. After full expansion, the expanders were taken out along with the scars excised, and the expanded skin flaps were transplanted to cover the defects.Results Twenty-one scars were effectively treated and 35 expanders were used in the 16 cases. The size of the maximum scar repaired for one time was 14×16 cm2. The postooperative complications mostly involving hematomas occurred in four cases, in one of which the expander was exposed because of the hematoma?s pressure. Conclusion The clinical application of multiple skin expanders to the treatment of cicatricial calvities is of great promise. Key words： expander; skin dilation; cicatricial calvities; flap 瘢痕性秃发不仅有普通增生性瘢痕的瘙痒、疼痛等不适，而且因头部无毛发严重影响容貌、美观，给患者带来严重的身心障碍。由于部位特殊，手术治疗不仅要考虑去除瘢痕，主要是恢复头发的覆盖，尽可能地还患者正常的容貌及外观。植皮法去除了瘢痕但术区无毛发，头发种植术后毛发太稀，效果不理想。我科2003年至今采用多个大容量扩张器治疗头部巨大面积瘢痕性秃发16例，取得良好效果，现报告如下。 1 资料与方法 1.1 一般资料 本组16例，男11例，女5例。年龄8~32岁，平均18岁。瘢痕原因：烧伤14例，外伤1例，感染1例。瘢痕性质：增生性、萎缩性，基本无头发生长。瘢痕面积：大多呈不规则片状，部分多处瘢痕，面积9 cm×8 cm~14 cm×16 cm。 1.2 方法 1.2.1 估算所需扩张器总容量 首先测量瘢痕性秃发的面积，由于扩张后皮瓣部分回缩及修剪皮瓣会浪费部分扩张皮肤，瘢痕面积应较实际多出约20%~30%来计算。根据每缺损1 cm2需扩张4 m1 来计算扩张容量。所选扩张器容量为300~600 ml，形状有圆形、肾形、圆柱形等。 1.2.2 手术分两期进行 一期扩张器植入及皮肤扩张：由于瘢痕面积巨大，需植入扩张器多、容量大，手术剥离区域巨大，所有患者均全身麻醉，根据瘢痕部位及形状决定扩张器容量、形状及放置位置。注射1：20万肾上腺素盐水后于瘢痕边缘内侧行小切口