腹部扩张真皮下血管网皮瓣修复手背瘢痕的临床研究

CLINICAL STUDY ON ABDOMINAL EXPANDED SUBDERMAL VASCULAR PLEXUS SKIN FLAPS FOR REPAIRING DORSAL HAND SCAR

目的探讨应用腹部扩张真皮下血管网皮瓣修复手背及手指背侧大面积瘢痕的方法及临床疗效。方法 2005年5月-2010年10月,收治16例手背及手指背侧瘢痕患者。男13例,女3例;年龄10～35岁,平均22.5岁。致伤原因:烧伤10例,热压伤4例,烫伤2例。瘢痕形成1年6个月～2年,平均21个月。患者掌指关节与指间关节屈曲受限,瘢痕范围为11 cm×7 cm～18 cm×10 cm。一期行腹部扩张器置入术;注水完成2周后行二期手背瘢痕切除、扩张皮瓣带蒂移位修复术,扩张皮瓣范围为12 cm×9 cm～19 cm×12 cm;二期术后14 d行三期皮瓣断蒂以及手指分开、指蹼成形。腹部供区直接拉拢缝合。结果术后皮瓣均顺利成活,创面Ⅰ期愈合。供区切口均Ⅰ期愈合。16例患者均获随访,随访时间1年2个月～3年,平均2年3个月。皮瓣质地柔软,弹性佳。末次随访时手功能按手部指关节主动活动(TAM)法评定:获优13例,良2例,差1例;优良率93.7%。结论腹部扩张真皮下血管网皮瓣血供重建速度快、成活面积大、质地良好,是修复手背大面积瘢痕的较好方法。

Objective To explore the method and effectiveness of abdominal expanded subdermal vascular plexusskin flaps in repairing dorsal hand scar. Methods Between May 2005 and October 2010, 16 cases of dorsal hand scars were treated with the abdominal expanded flaps. There were 13 males and 3 females, aged 22.5 years on average （range, 10-35 years）. Defect was caused by burn in 10 cases, hot crush injury in 4 cases, and scald injury in 2 cases. The average scar formation was 21 months （range, 1 year and 6 months to 2 years）. The patients had flexion restriction of metacarpophalangeal joint andinterphalangeal joint. The scar size ranged from 11 cm× 7 cm to 18 cm× 10 cm. The expander was implanted in abdominal skin and inflated with water regularly at the first stage. After 2 weeks, the expanded pedicled flap was trasferred to repair wounds in which scars were excised. The flap size ranged from 12 cm× 9 cm to 19 cm× 12 cm. After being cut offthe pedicle at 14 days,the tlngers were divided, and the digital web was formed. The abdominal donor site was directly sutured. Results All flapssurvived. The wound and donor site achieved primary healing. Sixteen cases were followed up 1 year and 2 months to 3 years with an average of 2 years and 3 months. The flaps had soft texture and good flexibility. At last follow-up, hand function wasgraded as excellent in 13 cases, good in 2 cases, and poor in 1 case with an excellent and good rate of 93.7% according to the total active motion evaluation system. Conclusion Abdominal expanded subdermal vascular plexus skin flap is an effective method to repair large scar of the dorsal hand because it has satisfactory texture, fast rebuilding of blood supply, and large area of survival.