儿童颈部瘢痕挛缩畸形手术及康复

Surgery and Rehabilitation of Scar Contracture Deformity of Neck in Children

目的探讨儿童颈部瘢痕挛缩的手术方法及康复.方法自1998年4月～2004年12月,对56例2岁～12岁之间的Ⅰ-Ⅳ度颈部瘢痕畸形患者采用局部皮瓣、皮肤扩张术、局部皮瓣转移加全厚或中厚植皮等手术方法整复,并结合术后的颈托固定、理疗等防止瘢痕挛缩措施及主动及被动锻炼等综合治疗措施至少6个月.结果Ⅰ度畸形采用Z改形、五瓣成形术等10例;Ⅱ度患者采用局部皮瓣扩张后转移修复加中厚植皮5例,局部皮瓣转移加全厚或中厚植皮17例;Ⅲ-Ⅳ度患者采用局部皮瓣转移加全厚或中厚植皮共24例.术后近期效果良好,随访6个月～2年,4例颈部后仰活动轻微受限,6例所植皮片轻度挛缩.结论对儿童颈部瘢痕畸形,手术治疗结合功能锻炼,可获得良好的治疗效果.

Objective neck scar contracture. Methods To study the surgery and rehabilitation methods for dysfunction of From 1998 to 2004 ,there were 56 cases with Ⅰ - Ⅳ degree scar contracture aged from 2 years old to 12 years old patients were undertaken the operation by using Z plasty or five flaps plasty,local skin flap and/or skin graft , the expanded flap to repair the soft tissue defect after scar section. And followed the rehabilitation methods for at least 6 months. Results There were 10 cases were adopted Z plasty or five flaps plasty for degree Ⅰ deformity ;local skin flap and/or skin graft in 5 cases, the expanded flap and local flap were adopted in 17 cases,with degree Ⅱ and 24 cases were adopted local flap and skin grafts to repair the soft tissue defect for degree Ⅲ- Ⅳ After 6 months to 2 years follow up,the appearance and function of neck were excellent. Except 4 neck dysfunction, and 6 skin grafts contracture but not serious. Conclusion It was suggested that surgery treatment followed rehabilitation methods was a better method for repairing scar contracture deformity of neck in children.