皮肤扩张二期手术的经验探讨

Experiences and improvement of expanded skin flap transfer

目的：总结皮肤扩张二期手术有关经验，介绍部分改进之处．方法：通过１９９５－０１～１９９７－１２整形外科２６７例皮肤扩张二期术病历的统计与分析，总结①修复的缺损面积与扩张容量的关系．②球形扩张后皮肤如何充分利用．③电刀在二期术中应用的评价．④关于二期术后并发症及其防治．结果：①修复１ｃｍ２的缺损所需注水量较过去总结增加许多，不同部位有较大差异．②球形扩张皮瓣的充分利用需注重术前设计，关键是顶端扩张较充分的区域的舒平与利用．③电刀在二期术中使用不会损伤扩张器，因而大大缩短了手术时间和减少了出血量．④皮瓣远端血运障碍及坏死成为二期术后并发症中最突出的问题．结论：皮肤扩张二期手术所积累的经验以及术中使用电刀不会损伤扩张囊的操作改进，将大大提高手术的速度与质量，值得推广．为什么术后皮瓣远端血运障碍及坏死问题突出，值得重视与进一步探讨．

AIM: To summarize the experiences of the expanded skin flap transfers and introduce some improvement. METHODS:Reviewed 267 cases of secondary operation of tissue expansion from January, 1995 to December, 1997, and summarized: ① The relationship between the repaired area of defect and volume of expansion. ② How to utilized the skin after spherical expansion maximally. ③ Evaluate the appliance of electrocoagulator in the operation. ④ The complications and their prevention and treatment. RESULTS: ① The volume of injected water needed for repairing the 1 cm 2 defect area is much more than that had been reported before, and it varies a lot as to different region of body. ② If the maximum utilization of the spherical expanded flap is expected, attention should be paid to the preoperative design, especially the extension and utilization of the top area which expanded fully. ③ The appliance of electrocoagulator in the operation will not damage the expander and can reduce not only the time needed for operation much but also the amount of bleeding. ④ The most serious complication is ischemia and necrosis of the distance of the flap. CONCLUSION: The experiences accumulated in the expanded skin flap transfer and the appliance of electrocoagulator, which will improve the speed and quality of the operation was recommended. Attention should be paid to why the ischemia and necrosis of the distance of flap is so serious, it deserve further research.