Effect of expanded lateral thoracic abdominal flap transferred with pedicle on repairing large area of hypertrophic scar after burn of the upper extremity
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摘要: 目的 观察应用侧胸腹部扩张皮瓣带蒂转移整复上肢烧伤后大面积增生性瘢痕的效果。 方法 2008年10月—2015年10月,郑州市第一人民医院收治上肢烧伤创面愈合8个月~3年后,继发大面积增生性瘢痕患者12例,瘢痕面积为11 cm×7 cm~20 cm×10 cm,其中5例患者肘关节伸直、屈曲受限。根据瘢痕大小,采用患肢同侧侧胸腹部扩张皮瓣或联合上肢扩张皮瓣整复。侧胸腹部切口位于腋前线附近、上肢切口位于瘢痕缘,在浅筋膜层钝性剥离形成囊腔,置入适当大小扩张器后注射壶内置,按扩张器容积的1~3倍超量注水扩张。注水扩张结束后,切取胸外侧皮动脉供血的侧胸腹部扩张皮瓣、上肢扩张皮瓣。上肢扩张皮瓣局部推进覆盖周围瘢痕切除后继发创面;侧胸腹部扩张皮瓣带蒂转移整复瘢痕,蒂部缝合成皮管,供瓣区直接拉拢缝合。术后3周左右断蒂,术区缝合口愈合后行抗瘢痕治疗。 结果 共埋置18个扩张器,均未见扩张器置入后感染、外露等并发症。侧胸腹部扩张皮瓣面积为11 cm×7 cm~16 cm×11 cm;6例患者联合应用上肢扩张皮瓣,面积为8 cm×4 cm~9 cm×6 cm。术后皮瓣均成活,切口愈合。出院后随访6个月~2年,皮瓣修复处颜色、质地、厚薄与上肢正常皮肤接近,5例肘关节伸直、屈肘受限者得以纠正,3例患者术区缝合口遗留线状瘢痕明显、9例患者术区缝合口瘢痕轻微。 结论 侧胸腹部扩张皮瓣血管恒定、解剖容易,修复上肢烧伤后大面积增生性瘢痕后外观及功能恢复较好。Abstract: Objective To observe the effect of expanded lateral thoracic abdominal flap transferred with pedicle on repairing large area of hypertrophic scar after burn of the upper extremity. Methods Twelve patients with large area of secondary hypertrophic scar 8 month to 3 years after healing of burn wound on the upper extremity were hospitalized in Zhengzhou First People′s Hospital from October 2008 to October 2015, with scar area ranging from 11 cm×7 cm to 20 cm×10 cm. Five patients were with limited straightening and bending of elbow. The scars were reconstructed with ipsilateral expanded lateral thoracic abdominal flap or that combined with expanded upper extremity flap according to the area of scar. Lateral thoracic abdominal incision was located near the anterior axillary line, and upper extremity incision was located near scar edge. A capsule cavity was formed by blunt dissection in the superficial fascia layer. Expander with suitable capacity was implanted with the injection pot being built-in. Volume of water reaching 1 time to 3 times of the capacity of expander was injected for excessive expanding. The expanded lateral thoracic abdominal flap supplied by lateral thoracic cutaneous artery and expanded upper extremity flap were dissected after the completion of expanding. The expanded upper extremity flap was advanced locally to cover the surrounding secondary wound after resection of hypertrophic scar. The expanded lateral thoracic abdominal flap was transferred with pedicle to reconstruct scar, with pedicle being sutured in skin tube-like shape, and the flap donor site was sutured directly. Flap pedicle separation was carried out 3 weeks after surgery. Anti-scar treatment was carried out after healing of sutured area. Results Totally 18 expanders were implanted, without complications such as infection, exposure of expander, and so on. The areas of expanded lateral thoracic abdominal flaps were from 11 cm×7 cm to 16 cm×11 cm. The combined application of expanded upper extremity flaps with area ranging from 8 cm×4 cm to 9 cm×6 cm was used in 6 patients. All the flaps survived with incision healed. The color, texture, and thickness of skin area repaired by flap were close to those of the normal skin of upper extremity after 6 months to 2 years′ follow-up afer discharge. The limited straightening and bending of elbow in 5 patients were rectified. Obvious linear scar was observed in the sutured area of surgery in 3 patients, while light linear scar was observed in the sutured area of surgery in 9 patients. Conclusions Expanded lateral thoracic abdominal flap has constant blood vessel and is easy to be dissected. It can achieve well reconstruction of appearance and function in repairing large area of hypertrophic scar after burn of the upper extremity.
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Key words:
- Burns /
- Cicatrix /
- Upper extremity /
- Surgical flaps /
- Tissue expansion devices
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