皮肤外扩张术修复较大面积皮肤软组织缺损

Application of external skin expansion in repair of massive skin and soft tissue defects

目的观察皮肤外扩张术修复较大面积皮肤软组织缺损的疗效。方法选择笔者单位收治的10例较大面积皮肤软组织缺损患者。缺损创面分布于小腿7例、膝部及周围2例、前臂1例，面积10cm×4cm～24cm×15cm。所有患者均采用外固定支架进行皮肤组织外扩张2～3周，之后拉拢缝合或辅以皮瓣（皮片）移植封闭创面。结果4例患者创面经皮肤外扩张后直接缝合完全封闭；5例创面明显缩小，剩余创面植以游离皮片；1例膝部周围创面虽明显变小但未完全封闭，行局部皮瓣转移覆盖创面，供区植皮治疗。术后随访1～12个月，患者病变部位创面愈合，外形较美观，皮肤感觉正常。结论皮肤外扩张术操作简单、创伤小、费用低，可明显缩小甚至封闭创面，修复大面积皮肤软组织缺损效果较好。

Objective To evaluate the clinical effect of external tissue expansion in the repair of massive skin and soft tissue defects. Methods From August 1998 to January 2004, 10 patients with massive skin and soft tissue defects （ the area ranging from 10 cm × 4 cm to 24 cm × 15 cm）, including 7 with wounds in the leg, 2 with wounds in knee region, and 1 with wounds in the forearm, were enrolled in the study. All patients were subjected to external tissue expansion together with external skeletal fixation for 2 - 3 weeks, then the wounds were closed with suturing or supplemented with skin flaps. Results The defects were closed completely after external expansion in 4 cases, and in other 5 cases the wounds were significantly decreased in area, and the residual wounds were covered with free skin grafting. In 1 case the wound could only be reduced in size, and the residual wound was closed with a local flap. Follow-up from 1 to 12 months showed that the wounds were closed with normal cutaneous sensation and good appearance. Conclusion External skin expansion is a simple, economical method for repair of massive skin soft-tissue defect, which can significantly be reduced or entirely closed.