肩胛部超比例筋膜皮瓣治疗腋窝重度瘢痕挛缩

Hyper-proportion fascio-cutaneaous flap in scapular region for the treatment of severe postburn axillary scar contracture

目的探讨肩胛部超比例筋膜皮瓣在治疗烧伤后腋窝重度瘢痕挛缩畸形的整复效果。方法根据腋窝挛缩瘢痕松解后其皮肤及软组织的缺损面积,设计以旋肩胛动脉为轴心血管蒂的比例为3∶1~4∶1的肩胛部超比例筋膜皮瓣,带蒂局部转移修复腋窝创面。皮瓣面积为18cm×5cm^24cm×8cm。结果本组15例患者,皮瓣全部成活;供区创面联合植皮修复者4例,直接拉拢缝合者11例。术后经3~18个月的随访,12例患者上肢及肩关节的功能基本恢复;3例患者因挛缩畸形较重,但上肢及肩关节的功能也较术前明显改善。结论肩胛部筋膜皮瓣具有供区隐蔽、血管蒂解剖位置恒定、管径粗和筋膜血管网丰富等优点,同时具有耐感染、耐压、适应性强及不易发生挛缩等特点。应用肩胛部超比例筋膜皮瓣整复烧伤后腋窝重度瘢痕挛缩畸形,可取得满意的疗效。

Objective To explore the effect of hyper- proportion fascio - cutaneaous flap in scapular region on the treatment of severe postburn axillary scar contracture. Methods According to the defect area of skin and soft tissue after axillary scar solution, the hyer- proportion fascio- cutaneaous flap in scapular region pedicled circumflex scapular artery was designed, and the flap proportion was 3 ： 1 to 4 ： 1, then the flap with pedicle was transplanted to cover the exposed surface. The maximum flap area was 24 cm × 8 cm, the minimum was 18 cm× 5 cm. Results All flaps in 15 patients survived, donor areas in 4 patients were covered with free skin graft, the other donor areas in 11 patients were sutured. After 3 ～ 18 months follow - up, the function of upper limb and shoulder joint recovered in 12 patients, the function improved obviously in 3 patients with the serious scar contracture deformity. Conclusion The fascio- cutaneaous flap in scapular region had the advantages of the masked donor area, constant anatomical position of the vessel pedicle, large diameter of the vessel and abundant fascio - cutaneous vascular net, and also had the features of anti - infection, anti - pressure, strong fitness and non - contracture. The treatment of severe postburn axillary scar contracture with hyer - proportion fascio - cutaneaous flap in scapular region could obtain satisfactory therapeutic effect.