儿童全厚植皮供皮区的优化选择及切口设计

Selection of donor site and design of incision for full-thickness skin grafting in children

背景:儿童与成人皮肤的生理特点存在差异,有必要制定适合儿童个体皮肤特点的全厚植皮供皮区的优化选则及切口设计方案。目的:探讨儿童全厚植皮供皮区的优化选择及切口设计的最佳方案。设计、时间及地点:病例分析,于2005-01/2007-12在重庆医科大学儿童医院烧伤整形科完成。对象:181例患儿,瘢痕挛缩畸形114例,先天性畸形37例,外伤皮肤缺损等30例。男105例,女78例,年龄4个月～14岁。方法:对181例行全厚植皮术的患儿,针对皮肤缺损的部位、面积,结合患儿的年龄、性别等特点选择最佳的供皮区:①切口部位应尽可能隐蔽。②供皮后的供区创口应能完全缝合。③供皮区皮肤的质地应与受区相近。④受区条件欠佳时尽量选择皮肤较薄的供皮区。⑤供皮区创口要便于护理。⑥修复大面积创面可由多部位同时供皮。⑦分次手术皮源紧张时可由原供皮区二次供皮。并针对儿童不同部位供皮区的个体特点进行切口设计:①切口形状应能保证获取足够面积的皮片。②缝合后的切口形状应尽量呈曲线,并顺应皮纹或皮肤张力线。③应避免切口缝合后使临近器官或皮肤体表标志变形,移位。④切口应避开体毛生长区。主要观察指标:移植皮片的存活率及存活后皮片的质量。供皮区切口的隐蔽性、瘢痕性状,局部皮肤的正常生理特点有无破坏。结果:171例移植皮片完全存活,32例发生表皮坏死,经换药痊愈,供皮区伤口均一期愈合。术后随访3个月～3年,移植皮肤性状良好,供皮区创痕呈线状,部位隐蔽。结论:针对儿童个体特点进行全厚植皮供皮区选择及切口设计,可在保证切取皮片面积足够的前提下,使皮片质地尽可能与受区接近,且供区创口隐蔽,美观,符合生理及美容的要求。

BACKGROUND： The physiological feature of children＇ skin is different from adult. It is necessary to institute optimum scheme of donor sites for full-thickness skin grafting in children according to the special feature of children＇s skin. OBJECTIVE： To study how to select the optimum donor site and to design the shape of incision in donor site for children＇s full-thickness skin graft. DESIGN, TIME AND SETTING： Analysis of cases was performed at Department of Burns and Plastic Surgery of Children＇s Hospital of Chongqing Medical University from January 2005 to December 2007. PARTICIPANTS： A total of 181 children cases were used in this study, including 114 cases of cicatricial contracture deformation, 37 cases of congenital deformity, and 30 cases of post injury cutaneous deficiency. Among the cases, there were 105 males and 78 females with age from 4 months to 14 years old. METHODS： Totally 181 cases undergoing full-thickness skin grafting were analyzed to select the optimum donor site according to the position and area of skin deficiency and the children＇ s age and sex by following rules： ①the donor site should be concealed as far as possible; ②the wound of donor site should be closed;. ④the texture of skin in donor site should be similar with recipient site;③ the thinner skin should be selected if the recipient site is not so good for thicker skin;⑤the selected donor site should be easy to be attended; ⑥more than one donor site could be selected at same time when more skin be needed and try to select the symmetrical sites ⑦the previous donor site could be used repeatedly if facing shortage of skin. Moreover, the shape of incision in donor site was designed according to the features of donor site by following rules： ①adequate skin could be harvested; ②the wound should be curve as far as possible; ③local physiological features should not be destroyed. MAIN OUTCOME MEASURES： The survival rate and the quality of free skin graft; The crypticity and the feature of scar of incision in donor site; whether normat features of skin in donor site had destruction. RESULTS： Totally 171 cases free skin graft were completely survived with 32 cases had epidermic necrosis which healed by changing dressings. All wounds of donor sites had primary healing. Follow-up was performed 3 months to 3 years after operation, the characteristics of transplant skin were fine and scars of donor wound were linear and well-concealed. CONCLUSION： According to children＇s individual characteristic, selection of donor site and design of donor incision can be performed so as to ensure not only harvesting adequate skin, but also marching recipient sites. The wounds in donor site are concealed and corresponding the aesthetic requirement.