定向皮肤软组织扩张器在腹部瘢痕整复中扩张规律的前瞻性研究

薛继东; 梁琰; 邢培朋; 狄海萍; 张建; 杨高远; 夏成德

doi:10.3760/cma.j.cn501120-20211123-00392

定向皮肤软组织扩张器在腹部瘢痕整复中扩张规律的前瞻性研究

doi: 10.3760/cma.j.cn501120-20211123-00392

郑州市第一人民医院烧伤科，郑州　　450004

基金项目:

河南省医学科技攻关计划（联合共建）项目 LHGJ20190999

河南省二〇一九年科技发展计划 192102310368

详细信息

通讯作者:
夏成德，Email：2273451508@qq.com

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出版历程
- 收稿日期: 2021-11-23

A prospective study on the expansion rule of the directional skin and soft tissue expander in abdominal scar reconstruction

Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China

Funds:

The Joint Project of Henan Medical Science and Technology Research Program of China LHGJ20190999

Science and Technology Development Plan of Henan Province of China in 2019 192102310368

More Information

Corresponding author: Xia Chengde, Email: 2273451508@qq.com

摘要

摘要: 目的观察定向皮肤软组织扩张器（以下简称扩张器）在腹部瘢痕整复中的扩张规律。方法采用前瞻性自身对照研究方法。采用随机数字表法选择2018年1月—2020年12月郑州市第一人民医院收治的20例符合入选标准的腹部瘢痕患者，其中男5例、女15例，年龄12~51（31±12）岁，Ⅰ型瘢痕患者12例、Ⅱ型瘢痕患者8例。Ⅰ期在瘢痕两侧置入额定容量为300~600 mL的扩张器2或3枚，其中至少1枚额定容量为500 mL（作为后续观察对象）。拆线后开始注水治疗，扩张时间为4~6个月，注水量达扩张器额定容量2.0倍后，Ⅱ期行腹部瘢痕切除+扩张器取出+局部扩张皮瓣转移修复。分别测定注水量达扩张器额定容量1.0、1.2、1.5、1.8、2.0倍时扩张处的皮肤表面积，并计算扩张相应倍数（1.0、1.2、1.5、1.8、2.0倍）和相邻倍数区间（1.0~1.2、1.2~1.5、1.5~1.8、1.8~2.0倍）时扩张处的皮肤扩张率；测定术后0（即刻）、1、2、3、4、5、6个月时修复处的皮肤表面积，并计算术后不同时间点（术后1、2、3、4、5、6个月）和术后不同时间段（术后0~1、1~2、2~3、3~4、4~5、5~6个月）修复处的皮肤回缩率。对数据行重复测量方差分析、LSD-t检验。结果与扩张1.0倍［（287.6±2.2）cm²、（47.0±0.7）%］比较，扩张1.2、1.5、1.8、2.0倍时患者扩张处的皮肤表面积和扩张率［（315.8±2.1）、（356.1±2.8）、（384.9±1.6）、（386.2±1.5）cm²，（51.7±0.6）%、（57.2±0.6）%、（60.4±0.6）%、（60.5±0.6）%］均明显增加（t值分别为46.04、90.38、150.14、159.55，45.11、87.83、135.82、118.48，P<0.05）；与扩张1.2倍比较，扩张1.5、1.8、2.0倍时患者扩张处的皮肤表面积和扩张率均明显增加（t值分别为49.82、109.64、122.14，144.19、49.51、105.85，P<0.05）；与扩张1.5倍比较，扩张1.8倍（t值分别为38.93、39.22，P<0.05）、2.0倍（t值分别为38.37、38.78，P<0.05）时患者扩张处的皮肤表面积和扩张率均明显增加；与扩张1.8倍比较，扩张2.0倍时患者扩张处的皮肤表面积和扩张率差异均无统计学意义（t值分别为4.71、4.72，P>0.05）。与扩张1.0~1.2倍比较，扩张1.2~1.5倍时患者扩张处的皮肤扩张率明显增加（t=6.95，P<0.05），扩张1.5~1.8、1.8~2.0倍时患者扩张处的皮肤扩张率均明显降低（t值分别为5.89、40.75，P<0.05）；与扩张1.2~1.5倍比较，扩张1.5~1.8、1.8~2.0倍时患者扩张处的皮肤扩张率均明显降低（t值分别为10.50、41.92，P<0.05）；与扩张1.5~1.8倍比较，扩张1.8~2.0倍时患者扩张处的皮肤扩张率明显降低（t=32.60，P<0.05）。与术后0个月比较，术后1、2、3、4、5、6个月患者修复处的皮肤表面积均明显减少（t值分别为61.66、82.70、96.44、102.81、104.51、102.21，P<0.05）；与术后1个月比较，术后2、3、4、5、6个月患者修复处的皮肤表面积均明显减少（t值分别为37.37、64.64、69.40、72.46、72.62，P<0.05）、回缩率均明显增加（t值分别为32.29、50.00、52.67、54.76、54.62，P<0.05）；与术后2个月比较，术后3、4、5、6个月患者修复处的皮肤表面积均明显减少（t值分别为52.41、60.41、70.30、65.32，P<0.05）、回缩率均明显增加（t值分别为52.97、59.29、69.68、64.50，P<0.05）；与术后3个月比较，术后4、5、6个月患者修复处的皮肤表面积均明显减少（t值分别为5.53、38.00、38.52，P<0.05）、回缩率均明显增加（t值分别为25.36、38.59、37.47，P<0.05）；与术后4个月比较，术后5、6个月患者修复处的皮肤表面积（t值分别为41.10、50.50，P>0.05）和回缩率（t值分别为48.09、50.00，P>0.05）差异均无统计学意义；与术后5个月比较，术后6个月患者修复处的皮肤表面积和回缩率差异均无统计学意义（t值分别为9.40、9.59，P>0.05）。与术后0~1个月比较，术后1~2、2~3、3~4、4~5、5~6个月患者修复处的皮肤回缩率均明显降低（t值分别为13.56、40.00、49.21、53.97、57.68，P<0.05）；与术后1~2个月比较，术后2~3、3~4、4~5、5~6个月患者修复处的皮肤回缩率均明显降低（t值分别为12.37、27.72、30.16、31.67，P<0.05）；与术后2~3个月比较，术后3~4、4~5、5~6个月患者修复处的皮肤回缩率均明显降低（t值分别为33.73、41.31、54.10，P<0.05）；与术后3~4个月比较，术后4~5、5~6个月患者修复处的皮肤回缩率差异均无统计学意义（t值分别为10.90、23.60，P>0.05）；与术后4~5个月比较，术后5~6个月患者修复处的皮肤回缩率差异无统计学意义（t=20.90，P>0.05）。结论扩张器能有效扩张腹部皮肤，从而修复腹部瘢痕畸形，注水扩张达扩张器额定容量1.8倍后维持扩张1个月，可以作为Ⅱ期手术时间节点。
- 瘢痕 /
- 扩张术 /
- 组织扩张装置 /
- 腹部 /
- 扩张率
Abstract: Objective To observe the expansion rule of directional skin and soft tissue expander (hereinafter referred to as expander) in abdominal scar reconstruction. Methods A prospective self-controlled study was conducted. Twenty patients with abdominal scar who met the inclusion criteria and admitted to Zhengzhou First People's Hospital from January 2018 to December 2020 were selected by random number table method, including 5 males and 15 females, aged 12-51 (31±12) years, with 12 patients of type Ⅰ scar and 8 patients of type Ⅱ scar. In the first stage, two or three expanders with rated capacity of 300-600 mL were placed on both sides of the scar, of which at least one expander had rated capacity of 500 mL (as the follow-up observation object). After the sutures were removed, water injection treatment was started, with the expansion time of 4 to 6 months. After the water injection volume reached 2.0 times of the rated capacity of expander, abdominal scar excision+expander removal+local expanded flap transfer repair was performed in the second stage. The skin surface area at the expansion site was measured respectively when the water injection volume reached 1.0, 1.2, 1.5, 1.8, and 2.0 times of the rated capacity of expander, and the skin expansion rate of the expansion site at corresponding multiples of expansion (1.0, 1.2, 1.5, 1.8, and 2.0 times) and adjacent multiple intervals (1.0-1.2, 1.2-1.5, 1.5-1.8, and 1.8-2.0 times) were calculated. The skin surface area of the repaired site at 0 (immediately), 1, 2, 3, 4, 5, and 6 months after operation, and the skin shrinkage rate of the repaired site at different time points (1, 2, 3, 4, 5, and 6 months after operation) and different time periods (0-1, 1-2, 2-3, 3-4, 4-5, and 5-6 months after operation) were calculated. Data were statistically analyzed with analysis of variance for repeated measurement and least significant difference-t test. Results Compared with the expansion of 1.0 time ((287.6±2.2) cm² and (47.0±0.7)%), the skin surface area and expansion rate of the expansion site of patients ((315.8±2.1), (356.1±2.8), (384.9±1.6), and (386.2±1.5) cm², (51.7±0.6)%, (57.2±0.6)%, (60.4±0.6)%, and (60.5±0.6)%) were significantly increased when the expansion reached 1.2, 1.5, 1.8, and 2.0 times (with t values of 46.04, 90.38, 150.14, 159.55, 45.11, 87.83, 135.82, and 118.48, respectively, P<0.05). Compared with the expansion of 1.2 times, the skin surface area and expansion rate of the expansion site of patients were significantly increased when the expansion reached 1.5, 1.8, and 2.0 times (with t values of 49.82, 109.64, 122.14, 144.19, 49.51, and 105.85, respectively, P<0.05). Compared with the expansion of 1.5 times, the skin surface area and expansion rate of the expansion site of patients were significantly increased when the expansion reached 1.8 times (with t values of 38.93 and 39.22, respectively, P<0.05) and 2.0 times (with t values of 38.37 and 38.78, respectively, P<0.05). Compared with the expansion of 1.8 times, the skin surface area and expansion rate of the expansion site of patients both had no statistically significant differences when the expansion reached 2.0 times (with t values of 4.71 and 4.72, respectively, P>0.05). Compared with the expansion of 1.0-1.2 times, the skin expansion rate of the expansion site of patient was significantly increased when the expansion reached 1.2-1.5 times (t=6.95, P<0.05), while the skin expansion rate of the expansion site of patient was significantly decreased when the expansion reached 1.5-1.8 and 1.8-2.0 times (with t values of 5.89 and 40.75, respectively, P<0.05). Compared with the expansion of 1.2-1.5 times, the skin expansion rate of the expansion site of patient was significantly decreased when the expansion reached 1.5-1.8 and 1.8-2.0 times (with t values of 10.50 and 41.92, respectively, P<0.05). Compared with the expansion of 1.5-1.8 times, the skin expansion rate of the expansion site of patient was significantly decreased when the expansion reached 1.8-2.0 times (t=32.60, P<0.05). Compared with 0 month after operation, the skin surface area of the repaired site of patient at 1, 2, 3, 4, 5, and 6 months after operation was significantly decreased (with t values of 61.66, 82.70, 96.44, 102.81, 104.51, and 102.21, respectively, P<0.05). Compared with 1 month after operation, the skin surface area of the repaired site of patient was significantly decreased at 2, 3, 4, 5, and 6 months after operation (with t values of 37.37, 64.64, 69.40, 72.46, and 72.62, respectively, P<0.05), while the skin shrinkage rate was significantly increased (with t values of 32.29, 50.00, 52.67, 54.76, and 54.62, respectively, P<0.05). Compared with 2 months after operation, the skin surface area of the repaired site of patient was significantly decreased at 3, 4, 5, and 6 months after operation (with t values of 52.41, 60.41, 70.30, and 65.32, respectively, P<0.05), while the skin shrinkage rate was significantly increased (with t values of 52.97, 59.29, 69.68, and 64.50, respectively, P<0.05). Compared with 3 months after operation, the skin surface area of the repaired site of patient was significantly decreased at 4, 5, and 6 months after operation (with t values of 5.53, 38.00, and 38.52, respectively, P<0.05), while the skin shrinkage rate was significantly increased (with t values of 25.36, 38.59, and 37.47, respectively, P<0.05). Compared with 4 months after operation, the skin surface area (with t values of 41.10 and 50.50, respectively, P>0.05) and skin shrinkage rate (with t values of 48.09 and 50.00, respectively, P>0.05) of the repaired site of patients at 5 and 6 months after operation showed no statistically significant differences. Compared with 5 months after operation, the skin surface area and skin shrinkage rate of the repaired site of patient at 6 months after operation showed no statistically significant differences (with t values of 9.40 and 9.59, respectively, P>0.05). Compared with 0-1 month after operation, the skin shrinkage rate of the repaired site of patient at 1-2, 2-3, 3-4, 4-5, and 5-6 months after operation was significantly decreased (with t values of 13.56, 40.00, 49.21, 53.97, and 57.68, respectively, P<0.05). Compared with 1-2 months after operation, the skin shrinkage rate of the repaired site of patients at 2-3, 3-4, 4-5, and 5-6 months after operation was significantly decreased (with t values of 12.37, 27.72, 30.16, and 31.67, respectively, P<0.05). Compared with 2-3 months after operation, the skin shrinkage rate of the repaired site of patients at 3-4, 4-5, and 5-6 months after operation was significantly decreased (with t values of 33.73, 41.31, and 54.10, respectively, P<0.05). Compared with 3-4 months after operation, the skin shrinkage rate of the repaired site of patient at 4-5 and 5-6 months after operation showed no statistically significant differences (with t values of 10.90 and 23.60, respectively, P>0.05). Compared with 4-5 months after operation, the skin shrinkage rate of the repaired site of patient at 5-6 months after operation showed no statistically significant difference (t=20.90, P>0.05). Conclusions The expander can effectively expand the abdominal skin, thus repairing the abdominal scar deformity. Maintained expansion for one month after the water injection expansion reaches 1.8 times of the rated capacity of the expander can be set as a phase Ⅱ operation node.
- Cicatrix /
- Dilatation /
- Tissue expansion devices /
- Abdomen /
- Expansion efficiency
薛继东、邢培朋、张建：手术操作、数据收集、论文撰写；梁琰、杨高远：数据整理、统计学分析；狄海萍、夏成德：研究指导、论文修改

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薛继东、邢培朋、张建：手术操作、数据收集、论文撰写；梁琰、杨高远：数据整理、统计学分析；狄海萍、夏成德：研究指导、论文修改

所有作者均声明不存在利益冲突

参考文献(26)

[1]	林燕娴,宋维铭.扩张皮瓣血运障碍监测技术及防治研究进展[J].中国修复重建外科杂志,2018,32(1):118-124. DOI: 10.7507/1002-1892.201708056.
[2]	陶思一,马红丽,程新德,等.皮肤软组织扩张术在面部瘢痕修复中的应用[J].蚌埠医学院学报,2010,35(4):389-390. DOI: 10.3969/j.issn.1000-2200.2010.04.024.
[3]	殷国前,滕晓颦,王刚,等.定向与非定向皮肤扩张的临床应用及组织学改变[J].中国组织工程研究与临床康复,2011,15(7):1305-1308.DOI: 10.3969/j.issn.1673-8225.2011.07.037.
[4]	袁文达,齐向东,张斌.计算机辅助技术在软组织扩张术中的临床应用[J].中国美容整形外科杂志,2016,27(5):300-303. DOI: 10.3969/j.issn.1673-7040.2016.05.014.
[5]	付时章,殷国前,杨晓楠.定向皮肤扩张器在面颈部瘢痕治疗中的应用[J].中国美容医学,2006,15(3):276-278,中插4.DOI: 10.3969/j.issn.1008-6455.2006.03.022.
[6]	鲁开化, 郭树忠, 韩岩,等. 皮肤软组织扩张术临床应用经验总结[J]. 中国美容医学, 2007, 16(11):1476-1480. DOI: 10.3969/j.issn.1008-6455.2007.11.002.
[7]	王占统,丁健科,余州,等.扩张术修复头面部瘢痕的临床应用进展[J].中华实验外科杂志,2020,37(7):1379-1383.DOI: 10.3760/cma.j.cn421213-20191230-00925.
[8]	董琛,余州,马显杰.皮肤软组织扩张方法与机制的研究进展[J].中华实验外科杂志,2019,36(8):1513-1517.DOI: 10.3760/cma.j.issn.1001-9030.2019.08.057.
[9]	刘士强, 马显杰. 皮肤软组织扩张术的应用进展与展望[J]. 中华整形外科杂志,2019,35(10): 949-952. DOI: 10.3760/cma.j.issn.1009-4598.2019.10.001.
[10]	王欢,范飞,王盛,等.腹部皮肤软组织扩张术的效果观察[J].中国美容医学,2011,20(6):909-911. DOI: 10.3969/j.issn.1008-6455.2011.06.010.
[11]	PamplonaDC,WeberHI,LetaFR.Optimization of the use of skin expanders[J].Skin Res Technol,2014,20(4):463-472.DOI: 10.1111/srt.12141.
[12]	黄长瑾,宋维铭.皮肤软组织扩张术:历史、发展、技术变革及临床应用创新[J].中国组织工程研究,2018,22(8):1267-1274. DOI: 10.3969/j.issn.2095-4344.0147.
[13]	宋成,殷培培,孙颖.皮肤软组织扩张技术在面颈部瘢痕手术中的应用效果及对瘢痕恢复的影响研究[J].中国医疗美容,2019,9(2):48-52.DOI: 10.19593/j.issn.2095-0721.2019.02.014.
[14]	刘柳,蔡国斌,陈光宇,等.重复皮肤组织扩张术的临床、生物力学及病理观察[J].中华医学美学美容杂志,2008,14(2):82-84. DOI: 10.3760/cma.j.issn.1671-0290.2008.02.004.
[15]	宋慧锋,柴家科,陈敏亮,等.垂直微创切口皮肤软组织扩张器置入术[J].中国修复重建外科杂志,2006,20(1):86-87.
[16]	董琛,余州,刘维,等.皮肤软组织扩张器置入部位感染风险的临床预测模型的构建与验证[J].中华烧伤杂志,2021,37(9):846-852.DOI: 10.3760/cma.j.cn501120-20200619-00314.
[17]	蒋永能,王会军,赵炳瑜,等.皮肤软组织扩张术在颈部瘢痕修复中的应用[J].中华整形外科杂志,2019,35(5):447-450.DOI: 10.3760/cma.j.issn.1009-4598.2019.05.006.
[18]	KarimiH,LatifiNA,MomeniM,et al.Tissue expanders; review of indications, results and outcome during 15 years' experience[J].Burns,2019,45(4):990-1004.DOI: 10.1016/j.burns.2018.11.017.
[19]	毛立亭,盛炜,于洪亮.扩张皮肤组织在头面颈部整形修复中的应用[J].实用临床医药杂志,2017,21(13):150-151.DOI: 10.7619/jcmp.201713048.
[20]	黄天翔,胡瑞斌,周丹亚,等.软组织扩张器的应用进展[J].中国美容整形外科杂志,2022,33(3):192,后插3-1-后插3-3.DOI: 10.3969/j.issn.1673-7040.2022.03.020.
[21]	徐昆明,黎洪棉,罗志军,等.皮肤软组织扩张器压力的实验研究[J].中国修复重建外科杂志,2013,27(3):316-319. DOI: 10.7507/1002-1892.20130073.
[22]	刘志飞,乔群,李晖,等.皮肤软组织扩张器注水量与扩张面积的关系[J].中华医学美学美容杂志,2001,7(1):4-6. DOI: 10.3760/cma.j.issn.1671-0290.2001.01.001.
[23]	施悦.皮肤组织扩张术的临床应用经验[J].中国美容医学,2009,18(1):105-106. DOI: DOI:10.3969/j.issn.1008-6455.2009.01.047.
[24]	常谨,刘硕,徐殿国,等.不同皮肤扩张方式对皮瓣的超微结构和回缩率的影响[J].现代口腔医学杂志,2012,26(5):322-325.
[25]	谢锋, 张正文, 马腾霄,等. 皮肤扩张移植后组织学实验研究[J]. 中华实验外科杂志, 2014, 31(3):529-531. DOI: 10.3760/cma.j.issn.1001-9030.2014.03.028.
[26]	范志宏,崔磊,刘凯.扩张皮肤回缩机理的实验研究[J].中华整形外科杂志,2000,16(3):143-145,插页(9). DOI: 10.3760/j.issn:1009-4598.2000.03.004.

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1 本组患者腹部瘢痕分型。1A.沿躯干纵向形成的，宽度在12 cm以内的瘢痕，称为Ⅰ型瘢痕；1B.沿腹部横向形成的瘢痕，称为Ⅱ型瘢痕

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2 采用定向皮肤软组织扩张器扩张皮瓣修复患者腹部Ⅰ型瘢痕。2A.Ⅰ期术前腹部瘢痕挛缩明显，局部略凹陷，周围皮肤褶皱，会阴部受牵拉；2B、2C.分别为注水量达扩张器额定容量2.0倍时，腹部正、侧位情况，扩张处皮肤可见清晰血管走行、无破溃；2D.Ⅱ期取出扩张器，切除腹部瘢痕，应用局部扩张皮瓣修复术后即刻；2E、2F.分别为术后10个月，腹部正、侧位情况，腹壁凹陷处较前膨出，褶皱皮肤伸展较前好转，会阴部未再受牵拉

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表1 20例腹部瘢痕患者采用定向皮肤软组织扩张器扩张相应倍数时扩张处的皮肤表面积和扩张率比较（x¯±s）

扩张倍数	表面积（cm²）	扩张率（%）
1.0	287.6±2.2	47.0±0.7
1.2	315.8±2.1^a	51.7±0.6^a
1.5	356.1±2.8^ab	57.2±0.6^ab
1.8	384.9±1.6^abc	60.4±0.6^abc
2.0	386.2±1.5^abc	60.5±0.6^abc
F值	8 677.20	8 382.41
P值	<0.001	<0.001
注：与扩张1.0倍比较，^aP<0.05；与扩张1.2倍比较，^bP<0.05；与扩张1.5倍比较，^cP<0.05

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表2 20例腹部瘢痕患者术后不同时间点修复处的皮肤表面积和回缩率比较（x¯±s）

术后时间点（个月）	表面积（cm²）	回缩率（%）
0	101±5	—
1	92±5^a	9.2±0.7
2	86±5^ab	14.7±1.1^b
3	83±5^abc	17.7±1.1^bc
4	82±5^abcd	18.5±1.2^bcd
5	82±5^abcd	18.9±1.2^bcd
6	82±5^abcd	19.0±1.2^bcd
F值	7 105.41	2 584.91
P值	<0.001	<0.001
注：与术后0个月（即刻）比较，^aP<0.05；与术后1个月比较，^bP<0.05；与术后2个月比较，^cP<0.05；与术后3个月比较，^dP<0.05；“—”表示无此项