胸科钢丝内固定联合皮片移植修复胸背部巨痣切除术后缺损

SKIN GRAFT COMBINED WITH THORAX WIRE FASTENING FOR REPAIRING POSTOPERATIVE COLOBOMA AFTER RESECTION OF CHEST BACK GIANT NEVUS

目的探讨胸科钢丝内固定联合皮片移植修复胸背部巨痣切除术后缺损的临床疗效。方法 2007年6月-2010年10月,收治17例胸背部巨痣患儿。男7例,女10例;年龄3岁6个月～15岁,平均8岁。巨痣范围为20 cm×12 cm～60 cm×50 cm。2例曾行激光治疗,余15例均未治疗。巨痣表面皮肤破溃及渗出2例,坚硬3例,毛发生长7例,5例皮肤质地与周围正常皮肤一致;5例皮肤瘙痒明显。手术切除巨痣后,于创缘以胸科钢丝内固定缩小创面,再取大腿中厚皮片移植修复创面。术后综合抗瘢痕治疗。结果巨痣切除后创面面积为(2 110.74±725.69)cm2,胸科钢丝缩创后面积为(1 624.94±560.57)cm2,缩创前后创面面积比较差异有统计学意义(t=9.006,P=0.001)。术后植皮均顺利成活,切口及供皮区创面均Ⅰ期愈合。患者术后均获随访,随访时间为6个月～2年,平均13个月。植皮区、供皮区无明显瘢痕增生或挛缩,皮肤色泽及弹性与创周正常皮肤相似,乳头、肚脐等局部器官与术前比较无牵拉移位。结论胸背部巨痣切除后,胸科钢丝内固定联合皮片移植修复继发创面,可减少取皮量,术后瘢痕轻微,外观满意。

Objective To observe the effectiveness of skin graft combined with thorax wire fastening for repairing postoperative coloboma after resection of chest back giant nevus.Methods Between June 2007 and October 2010,17 cases of chest back giant nevus were treated.There were 7 males and 10 females,aged from 3 years and 6 months to 15 years（mean,8 years）.The size of giant nevus was 20 cm × 12 cm to 60 cm × 50 cm.Two cases of them were ever treated by laser,while the others were never treated.The check before operation showed ulcer of the skin and effusion in 2 cases,hard skin in 3 cases,hair growth in 7 cases,and normal in 5 cases.Five cases had serious itch.After giant nevus was cut off,thorax wire was fastened to reduce the wound area,and then the intermediate split thickness skin graft of thigh was used to repair the wound.Comprehensive anti-scar treatment was given postoperatively.Results The wound size was（2 110.74 ± 725.69） cm2 after resection of giant nevus,and was（1 624.94 ± 560.57） cm2 after thorax wire fastening,showing significant difference（t=9.006,P=0.001）.All the grafting skin survived;the incision and wound at donor site healed by first intention.The patients were followed up 6 months to 2 years（mean,13 months）.No scar proliferation or contracture occurred.The skin color and elasticity were similar to the normal skin;the nipple,navel,and other local apparatus were not shifted after operation.Conclusion It can reduce donor site of skin and postoperative scar,and achieve satisfactory appearance to cover the wound by skin graft combined with thorax wire fastening after chest back giant nevus was cut off.