颈部瘢痕挛缩的整复治疗

Operative treatment of cicatrecal contracture of the neck

回顾性分析颈部瘢痕挛缩的治疗方法。自１９９６年６月～１９９７年５月收治１５６例颈部瘢痕挛缩，根据传统分类法分为Ⅰ、Ⅱ、Ⅲ、Ⅳ度，分别采用Ｚ成形术、皮片移植、轴型皮瓣等７种手术方法，其中颈胸真皮下血管网薄皮瓣１８例，肩胸皮瓣４例，扩张后皮瓣２例，超长下斜方肌皮瓣２例。２５例皮瓣成活良好，１例颈胸真皮下血管网薄皮瓣远端因加压包扎不当而部分坏死，皮片移植术后６例边缘及颈前活动部位皮肤小片状坏死，余均成活。根据颈部瘢痕的性质、畸形分度、组织缺损范围及深度，周围正常皮肤残存利用及松弛条件等综合考虑，选择修复方法。

To analyze retrospectively the operative treatment of scar contracture of the neck. 156 case suffering from burn scar contrature of the neck from June 1976 to May 1997, Ⅰ、Ⅱ、Ⅲ、Ⅳ types were divided according to traditional classification. Seven kind of method have been used such as Z-plasty, local flap combined with split thickness skin graft, subdermal vascular network skin flap with cutaneous branches of transverse cervical artery in 18, delto-pectoral skin flap in 4 case, lower trapezius myocutaneous flap in 2. Follow-up of 6 months to 2 years, the results were satisfactory and function improved. One thin flap was partly necrosed and healed with split skin graft. Skin healed following dressing changes in 6 cases of skin graft. Treatment of the different types should be individulized depending on the nature of scar, range of defects, skin condition around defects etc. We can choose better operative treatment and get satisfying results.