皮肤软组织扩张治疗小儿面颈部瘢痕

Application of tissue expansion in repair of cervicofacial burn scar in pediatric patients

目的总结皮肤软组织扩张器在小儿面颈部烧伤后瘢痕修复中的"V"型切口应用技巧,评价扩张术的应用效果。方法对32例患儿应用97枚扩张器行扩张皮瓣修复治疗面颈部烧伤后瘢痕。在瘢痕区内设计"V"型切口,切开皮肤全层后直视下分离出与扩张器大小相宜的皮下腔隙,置入扩张器,容量为80～300ml,注射壶外置。每2、3天注水一次,扩张时间约60d,超量扩张满意后行Ⅱ期手术修复面颈部瘢痕畸形。结果术后发生血肿2例,皮瓣坏死1例,切口裂开1例。随访6～12个月,32例患儿经Ⅱ期手术修复后取得良好的功能和外观效果,皮瓣质地、色泽理想。结论应用皮肤软组织扩张期治疗小儿面颈部烧伤瘢痕,节约皮源,减少供皮区瘢痕,可以达到良好的功能、外观修复效果,是首选治疗方法。

Objective To sum up the application of tissue expanders for reconstructing large cutaneous defects and evaluate the effects. Methods We reviewed 32 children who underwent tissue expansion of the head and neck burn scar regions. Most children underwent multiple expander implant bringing the total expanders number to 97. V - shape incision was designed in scar region which was close to expansive area. After sectioning full - thickness skin we dissociated proper soft tissue pockets adapt to the size of expander, left the valve outside. Tissue expander original volume ranged from 80-- 300 ml. The time of the tissue expansion pro- cess was about 60 days, affuslon with sodium chloride every 2, 3 days. After overexpansion the reconstructions were conducted as the expansion of a transposition or an advancement flap. Results After 6 -- 12 monthes postoperative follow - up, the appearance and functional restoration in 32 cases was satisfactory except for 2 eases with haematoma, 1 with flap necrosis and exposure respectively. Conalusion In pediatric patients, tissue expansion application is the best method for repairing cervicofacial burn scars in pediatric patients with sparing skin, reduced scar, good function and contour. Should continue to remain a viable reconstruction option.