肩胛部皮瓣在腋窝瘢痕挛缩畸形整复中的应用(1)
【摘要】 目的:观察应用肩胛部皮瓣转移修复腋窝严重瘢痕挛缩畸形的临床效果,总结肩胛部皮瓣在腋窝瘢痕挛缩畸形整复中的临床应用经验,并探讨其应用的可行性。方法:对本组11例13侧严重腋窝瘢痕挛缩畸形患者进行瘢痕松解、转移肩胛部皮瓣修复。结果:本组11例患者13侧肩胛部皮瓣完全成活,其中一例皮瓣远端皮下脂肪液化、裂开约2 cm,经换药缝合后愈合;创面均得以满意修复,术后随访6个月~2年,皮瓣色泽好,质地优良,不臃肿,外观满意,腋窝均未再次发生瘢痕挛缩,肩关节功能良好。结论:肩胛部皮瓣具有面积大、血供可靠、距离腋窝较近、切取方便、不牺牲主干血管及供区隐蔽、可直接缝合等优点,是修复腋窝瘢痕挛缩的理想方法之一。
【关键词】 肩胛部皮瓣; 腋窝瘢痕; 修复外科手术
【Abstract】 Objective:To study the clinical effect of repairing serious scar contracture of axilla by applying scapular region flap. To summarize the experiences of clinical scapular region flap application, and discuss its feasibility. Method: 11 patients with 13 parts of serious scar contracture of axilla were organized scar release. All patients got repaired by transferring scapular region flap.Result:11 patients with 13 parts of serious scar contracture of axilla getting repair were totally successful. Among them,one patient’s distal subcutaneous fat of flap became fat liquefaction, and with 2 cm dehiscence,changed fresh dressing and suturing, the repaired part healed. Doctors and patients all satisfied with wood surface. Post-operation follow-up 6 monthes to 2 years, all patients wood surface looked good without edema and the axilla never happen scar contracture again. Shoulder joint work normally. Conclusion:The scapular region flap is one of the best way of repairing scar contracture of axilla,which with following advantages:scapular region flap with large area,reliable blood supply,without sacrifice main blood vessel can be easily get,and can be directly sutured and so on.
, http://www.100md.com
【Key words】 Scapular region flap; Axillary scar; Reconstructive surgery
First-author’s address:Xingyi People’s Hospital,Xingyi 562400,China
doi:10.3969/j.issn.1674-4985.2015.07.044
腋窝深度烧伤早期治疗不当创面愈合后往往造成腋窝瘢痕挛缩畸形,从而导致肩关节外展活动受限,严重影响患者的生活质量,故后期整复治疗极为重要。根据瘢痕的范围、畸形的严重程度及其对功能影响的大小可分为轻度、中度及重度[1]。轻中度腋窝瘢痕挛缩可通过Z字改形、五瓣成形、局部皮瓣或中厚植皮进行修复,重度腋窝瘢痕挛缩往往需要行皮瓣转移修复才能满足其外观及功能的要求。本科于2009年1月-2013年12月采用肩胛部皮瓣转移修复重度腋窝瘢痕挛缩患者11例,共13侧。取得满意的治疗效果,报告如下。
, http://www.100md.com
1 资料与方法
1.1 一般资料 贵州省兴义市人民医院烧伤整形科2009年1月-2014年8月临床病例11例,男7例,女4例,年龄5~56岁,中位年龄31岁,共13侧,均为腋窝重度瘢痕挛缩畸形,经手术切除松解瘢痕后腋窝创面最大30 cm×14 cm,最小12 cm×5 cm;转移肩胛部皮瓣最大15 cm×14 cm,最小14 cm×8 cm。
1.2 术前准备 瘢痕破溃感染者常规取分泌物做细菌培养和药敏实验检查,围手术期应根据培养结果使用敏感抗生素治疗。对瘢痕反复破溃时间较长者,术前需行病理学检查,排除瘢痕癌变。
1.3 皮瓣设计 (1)皮瓣的旋转点:皮瓣旋转点为三边间隙,即旋肩胛动脉-三边间隙皮支穿出点,一般在肩峰与肩胛骨下角连线的中点附近。(2)皮瓣的轴心线:旋肩胛动脉-三边间隙皮穿支升支、横行支或降支为肩胛部体表投影线为皮瓣设计的轴心线,术前可用Doppler血流探测仪探测旋肩胛动脉-三边间隙皮穿支升支、横行支或降支血管搏动帮助确定皮瓣轴心线。(3)解剖平面:皮瓣位于深筋膜与肌膜之间。(4)皮瓣的切取范围:上界在肩胛冈下2 cm,下界在肩胛骨下角上2 cm,外侧界在肩胛骨外侧缘外2 cm,内侧界在脊柱外2 cm[2]。根据受区创面的形状和缺损范围,确定皮瓣的大小和位置,为避免缝合后张力过大而影响皮瓣血供,设计的皮瓣长和宽均应超出受区创面大小1~2 cm。, http://www.100md.com(周维忠等)
【关键词】 肩胛部皮瓣; 腋窝瘢痕; 修复外科手术
【Abstract】 Objective:To study the clinical effect of repairing serious scar contracture of axilla by applying scapular region flap. To summarize the experiences of clinical scapular region flap application, and discuss its feasibility. Method: 11 patients with 13 parts of serious scar contracture of axilla were organized scar release. All patients got repaired by transferring scapular region flap.Result:11 patients with 13 parts of serious scar contracture of axilla getting repair were totally successful. Among them,one patient’s distal subcutaneous fat of flap became fat liquefaction, and with 2 cm dehiscence,changed fresh dressing and suturing, the repaired part healed. Doctors and patients all satisfied with wood surface. Post-operation follow-up 6 monthes to 2 years, all patients wood surface looked good without edema and the axilla never happen scar contracture again. Shoulder joint work normally. Conclusion:The scapular region flap is one of the best way of repairing scar contracture of axilla,which with following advantages:scapular region flap with large area,reliable blood supply,without sacrifice main blood vessel can be easily get,and can be directly sutured and so on.
, http://www.100md.com
【Key words】 Scapular region flap; Axillary scar; Reconstructive surgery
First-author’s address:Xingyi People’s Hospital,Xingyi 562400,China
doi:10.3969/j.issn.1674-4985.2015.07.044
腋窝深度烧伤早期治疗不当创面愈合后往往造成腋窝瘢痕挛缩畸形,从而导致肩关节外展活动受限,严重影响患者的生活质量,故后期整复治疗极为重要。根据瘢痕的范围、畸形的严重程度及其对功能影响的大小可分为轻度、中度及重度[1]。轻中度腋窝瘢痕挛缩可通过Z字改形、五瓣成形、局部皮瓣或中厚植皮进行修复,重度腋窝瘢痕挛缩往往需要行皮瓣转移修复才能满足其外观及功能的要求。本科于2009年1月-2013年12月采用肩胛部皮瓣转移修复重度腋窝瘢痕挛缩患者11例,共13侧。取得满意的治疗效果,报告如下。
, http://www.100md.com
1 资料与方法
1.1 一般资料 贵州省兴义市人民医院烧伤整形科2009年1月-2014年8月临床病例11例,男7例,女4例,年龄5~56岁,中位年龄31岁,共13侧,均为腋窝重度瘢痕挛缩畸形,经手术切除松解瘢痕后腋窝创面最大30 cm×14 cm,最小12 cm×5 cm;转移肩胛部皮瓣最大15 cm×14 cm,最小14 cm×8 cm。
1.2 术前准备 瘢痕破溃感染者常规取分泌物做细菌培养和药敏实验检查,围手术期应根据培养结果使用敏感抗生素治疗。对瘢痕反复破溃时间较长者,术前需行病理学检查,排除瘢痕癌变。
1.3 皮瓣设计 (1)皮瓣的旋转点:皮瓣旋转点为三边间隙,即旋肩胛动脉-三边间隙皮支穿出点,一般在肩峰与肩胛骨下角连线的中点附近。(2)皮瓣的轴心线:旋肩胛动脉-三边间隙皮穿支升支、横行支或降支为肩胛部体表投影线为皮瓣设计的轴心线,术前可用Doppler血流探测仪探测旋肩胛动脉-三边间隙皮穿支升支、横行支或降支血管搏动帮助确定皮瓣轴心线。(3)解剖平面:皮瓣位于深筋膜与肌膜之间。(4)皮瓣的切取范围:上界在肩胛冈下2 cm,下界在肩胛骨下角上2 cm,外侧界在肩胛骨外侧缘外2 cm,内侧界在脊柱外2 cm[2]。根据受区创面的形状和缺损范围,确定皮瓣的大小和位置,为避免缝合后张力过大而影响皮瓣血供,设计的皮瓣长和宽均应超出受区创面大小1~2 cm。, http://www.100md.com(周维忠等)