用改良跟腱瘢痕瓣治疗瘢痕挛缩性足下垂11例

Eleven Patients Treared with Improved Scar Flaps in Tendo Calcaneus for Scar-contracted Drop Feet

目的 总结烧伤后瘢痕挛缩性足下垂的临床治疗经验。方法 对跟腱瘢痕瓣进行改良设计，不切开内侧瓣内缘切口。内侧瘢痕瓣不游离，借助辅助横切口。将踝关节复位。同时观察早期烧伤创面的不同处理方法和伤后至手术时间的长短对功能复位的影响。结果 改良跟腱瘢痕瓣同样能达到踝关节复位至功能位的要求，并且内侧瓣不易坏死；早期切痂者较削痂和自愈者瘢痕瓣坏死率高，病程在2年以上患者复位后效果较病程在0．5-2年患者的差。结论 改良跟腱瘢痕瓣血供丰富，挛缩的跟腱易于松解，安全性高；对烧伤早期切痂者手术时应慎重，手术时机最好在伤后1年左右。

Objective To summarize the experiences in the clinical therapy for scar-contracted drop feet after burn. Methods The design of burn scar flaps in tendo calcaneus was improved. In virtue of aeeessary transverse incision, ankle joints were reposited, without incision or free liberation of the internal side＇s scar flap. Results Improved scar flaps in tendo ealeaneus met the need of ankle joints＇functional reposition with an additional benefit that internal scar flaps were not prone to necrosis. But higher necrosis rate of scar flaps was found in the patients who accepted crust removal at early stage of burn than in those who accepted crust scraping or got to self-cure. The outcome of reposition was worse in the patients with over two years＇ course than in those with 0.5 - 2 years＇ course. Conclusion Improved scar flaps are not only abundant in blood supply, but also advantage the looseness of the contracted tendo calcaneus. Doctors should be careful of crust removal at early stage, and the best chance should be selected one year after burn.