烧伤后颌颈部瘢痕畸形手术方式评价

Evaluation on plastic surgery for cervico-mandibular scar contracture deformity after burn

【目的】探讨唇、下颌及颈部烧伤后瘢痕增生和挛缩畸形的手术方法及手术效果。【方法】总结68例唇、下颌及颈部烧伤后瘢痕增生和挛缩畸形的手术方法、手术时间及手术后愈合情况,评价手术效果。【结果】对68例患者的上唇、下唇、下颌及颈部4个部位,采用常规皮瓣、含真皮下血管网皮瓣、皮肤扩张术后皮瓣、全厚皮片移植、厚中厚皮片移植和薄中厚皮片移植6种手术方法进行整形;从愈合后是否有水泡、色素沉着的严重程度、是否臃肿、颌颈角形态、柔软度、有无坏死、远期有无收缩7个方面进行比较,各存在着不同的优缺点,其中含真皮下血管网皮瓣、皮肤扩张术后皮瓣、全厚皮片移植3种方法优点明显。【结论】应用含真皮下血管网皮瓣和扩张皮瓣覆盖手术创面,手术后效果更佳;全厚皮片移植效果较佳;其它手术方法应慎用。手术后尽早应用弹力颈托加压是保证手术效果的有效方法。

[ Objective] To explore the effect of plastic surgery for labial cervico-mandibular scar contracture deformity after burn. [Methods] Surgical methods, period and outcome of 68 patients with labial cervico-mandibular scar contracture deformity after burn were studied retrospectively. [Results] Sixty-eight cases with labial cervico-mandibular scar contracture deformity after bum received six plastic surgeries as skin flap, thin flap with subdermal vascular network, pre-expanded skin flap, free full-thickness skin gTaft and different partial thickness skin graft, respectively. Different significance existed through the comparison from seven aspects including blister, pigmentation, shape et al in the six plastic surgeical methods. The outcome of three plastic methols of thin flap with subdermal vascular network, pre-expanded skin flap and free full-thickness skin graft were better than the other methods. [ Conclusions] These results demonstrate that thin flap with subdermal vascular network and pre-expanded skin flap have many advantages, and it is particularly suitable for reconstruction of cervico-mandibular contracture after burns. Free full-thickness skin grit is much better than other methods of surgical reconstruction. Using other methods of surgical reconstruction should be cautious. Early pressure therapy after operation has the positive effect to prevent scar.