供区扩张的侧后腰背部大面积全厚皮片临床应用

Tissue expansion as a means of harvesting large fullthickness skin grafts for treatment of burn scar

目的探讨应用皮肤扩张术从侧后腰背部切取大面积全厚皮片的可行性及应用效果。方法对8例大面积烧伤后瘢痕，仅存侧后腰背部可为供皮区，于此部位按梭形取皮设计的两侧置人大容量扩张器5．6个，注水足量后，从11处（其中3例各取自左右两侧）侧后腰背部切取35～45cm×12～15cm的全厚皮片，移植到膝周、胭部等瘢痕切除后14～38cm×10～15cm的16处创面上。结果随诊6～29个月，侧后腰背部供皮区残留40～50cm长的缝合痕迹，植皮区皮肤外观、质地及关节屈伸功能近似正常。结论应用皮肤扩张术从侧后腰背部切取大面积全厚皮片是一种可行的方法，皮片移植后效果良好。

Objective To evaluate the possibility and results of application of skin expansion as a means of harvesting large full-thickness skin grafts for repair of bum scar. Methods Eight cases of application of skin and soft tissue expansion were reported. In those patients with deformity due to severe bum of large area with only back skin unburned. Five or six large soft tissue expander was used under the unburned back skin. Eleven expanded full-thickness grafts（bilaterally in 3 cases out of 8 cases） were used for posthum reconstruction. Grafts ranging in size from approximately 35 - 45cm（excluding the dimensions of one submental graft）to greater then 12 - 15cm were harvested from expanded donor sites on unilateral or bilateral back. Sixteen grafts were used on the lower extremity, including an entire knee surface and dorsal leg. Results All of the cases were successfully treated with little pain and minimized infection. Donor-site complications were negligible. The follow-up ranged from 6 months to 29 months. Conclusion Skin and soft tissue expansion in a safe and reliable measure in the treatment of deformity due to extensive severe bum injury and repair of severedeep electrical burned scalp and skull with fresh wound. Experience has demonstrated that expanded full-thickness grafts are excellent reconstructive option for posthum scar.