延期皮肤移植术在面颈部畸形修复中的应用(1)
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[摘要]目的:探讨并比较面颈部大范围自体皮移植手术中,延期手术与一次手术的成功率及愈后效果。方法:针对面颈部瘢痕、巨痣等在实施大面积自体皮移植手术时,手术分两种术式进行:一期术式即切除病变组织后立即行自体皮移植;延期术式则先行常规病变组织切除,包扎创面后48h再进行自体皮移植。术后交换敷料时间均为术后第7天,观察比较两种术式在皮片成活率、创面感染发生率、皮下血肿发生率、瘢痕增生发生率等方面的差异,以及患者治疗周期及治疗费用上的差异。结果:本组病例共49例,行一期术式者13人,行延期术式者36人,在皮片成活率(91.9%±4.5% vs 99.5%±1.2%)、皮下血肿发生率(92.3% vs 22.2%)、感染发生率(7.7% vs 2.8%)方面,二者有显著性差异(P<0.05)。两组在治疗周期上无显著性差异。治疗费用方面,延期手术组略高。随访结果显示,两组远期效果基本类似,但一期术式组的瘢痕形成及增生情况多于延期术式组。结论:面颈部实施大范围自体皮移植手术时采取延期植皮的方式,对保证手术的成功及愈后效果有重要作用。
[关键词]面颈部;自体皮移植;延期手术
[中图分类号]R622[文献标识码]A[文章编号]1008-6455(2010)09-1267-02
Delayed skin graft application for the repair of deformity on face and neck
HAN Jun-tao,XIE Song-tao,WANG Hong-tao,DONG Mao-long,ZHU Xiong-xiang,XU Ming-da,HU Da-hai
(Department of Burns and Cutaneous Surgery,Xijing Hospital,the Fourth Military Medical University,Xi'an 710032,Shannxi,China)
Abstract:ObjectiveTo investigate the difference between delayed and instant skin graft for repair the deformity on face and neck.MethodsTwo operation styles were applied when the large scale skin graft was needed for repair the deformity on face and neck. One was instant style that the skin was transplanted to the wound bed after the deformity area had been excised. Another was delayed way that the skin graft was done after the excision for 48 hours. The wound dressings were changed at 7th day after the operation and the skin take rate, infection rate, ecchymoma rate and long-term results were compared respectively.ResultsAll 49 cases were involved and 13 cases for the instant style and the other 36 cases for the delayed style. The difference was significant at skin take rate (91.9%±4.5% vs 99.5%±1.2%),ecchymoma rate (92.3% vs 22.2%) and infection rate (7.7% vs 2.8%). There was no difference in the total therapy time. The long-term results were similar but the more hypertrophic scar occurred in the instant style group. Conclusion The delayed operation was very important for guaranteeing the success and long-term results of large scale skin graft on face and neck.
Key words: face and neck; skin autograft; delayed operation ......
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