皮肤软组织扩张修复头面部外伤性缺损的早期应用

Early application of skin soft tissue expansion in repair of traumnatic scalp and facial defects

目的:常规应用植皮或单纯的皮瓣修复头面部皮肤软组织缺损从美学角度讲存在一定的缺点。总结皮肤软组织扩张器在头面部外伤性缺损早期修复中的应用情况。方法:①对象:选择2005-09/2007-10在解放军第四军医大学西京医院整形外科住院的部分外伤性头面部皮肤软组织缺损患者15例。其中男12例,女3例;年龄5～51岁。面部缺损4例,头皮缺损7例,面部并头皮缺损4例,缺损面积3cm×5cm～7cm×11cm。②方法:积极改善患者全身情况,加强局部创面处理,待全身情况稳定、创面肉芽组织新鲜的情况下,行清创、刃厚植皮术,覆盖除骨外露以外所有创面。同时或延期于缺损周围正常组织下埋置一至数枚容量不等(80～450mL)的扩张器。皮片成活并稳定后,开始扩张器注水,约两三个月注水完成后行扩张器二期术,切除骨外露周围不稳定的瘢痕组织(包括早期植皮部分),用设计的扩张皮瓣覆盖缺损,完成修复。结果:1例头皮扩张器在扩张后期出现了外露,及时进行二期手术修复缺损。所有患者头面部皮肤软组织缺损在短期内均得到了有效修复,2例患者在二期术后出现了轻度的器官移位,术后半年症状消失,所有病例无瘢痕性秃发发生。结论:皮肤扩张可用于头面部外伤性缺损的早期修复,合理的选择、正确的应用可以获得满意的效果。

AIM： The repairing results of the defect in facial skin soft tissues are not satisfactory by skin graft or skin flap. This study was designed to summarize the application of skin soft tissue expansion for early repair of scalp and facial defects suffered from trauma. METHODS： Fifteen patients with scalp and facial defects suffered from trauma, aged 5 51 years, were chosen from the Department of Plastic Surgery, Xijing Hospital, the Fourth Military Medical University of Chinese PLA from September 2005 to October 2007, including 12 males and 3 females. Among them, 4 cases were facial defect while 7 ones were scalp defect. Other 4 patients were scalp and facial defects with defect areas ranged from 3 cm × 5 cm to 7 cm × 11 cm. The system and region condition of the wounded were improved actively, after that, the necrotic tissues in wound were removed and split-thickness skin grafts were used to cover the defect apart from revealed bone. One to several expandors with unequal capacity （80-450 mL） were embedded under normal skin soft tissue surrounding the defect at the same time or later. After the skin grafts had turned alive and stable, normal sodium was injected into the expandor regularly. And 2-3 months later, the injection was finished and the secondary operation of expandor was performed, then the instable scar tissues around the revealed bone were excised （including the skin graft at the early period）, the expanded skin flaps were used to cover the defect for repairing. RESULTS： One patient with scalp expandor was exposed at the later period of expanding, which was repaired by the secondary operation in time. All the defects of scalp and facial defects had been repaired successfully at the short phase and the results of cure were satisfying. Two patients appeared slight organ shift after the secondary operation which disappeared a half year later. Scarred alopecia did not happened to all patients. CONCLUSION： Skin expansion is a choice for early repair of scalp and facial defects suffered from trauma. Proper choice and application can bring about satisfactory results.