预扩张腹部轴型皮瓣在上肢大面积瘢痕修复中的应用

The application of expansion of upper abdomen shaft flap in the large area of the scar tissue

目的探讨预扩张腹部轴型皮瓣修复上肢大面积瘢痕的方法及疗效。方法手术分3期进行,第1期根据上肢瘢痕部位及面积,选择旋髂浅动脉、腹壁浅动脉、腹壁下动脉的脐旁穿支、肋间后动脉外侧穿支中的一组腹部轴型皮瓣预先扩张;经过3～4个月的注水扩张后行第2期手术,将预扩张的腹部轴型皮瓣以带蒂转移的方式修复上肢瘢痕切除后的皮肤缺损;3周后再行第3期手术,即皮瓣断蒂。结果本组12例患者应用预扩张腹部轴型皮瓣15例,其中3例患者应用双侧预扩张腹部轴型皮瓣,皮瓣全部存活,外形不臃肿,颜色、质地与周围皮肤接近,患肢功能明显改善。结论预扩张腹部轴型皮瓣是修复上肢大面积瘢痕的一种非常有效的方法,能取得外形及功能均为满意的结果;但治疗周期长,需分次手术为其缺点。

Objective To investigate the methods and effects of reconstruction of the upper extremity with large-sized scar using the preexpanded abdominal-based axial flap.Methods The operation was performed in three stages.At the first stage,one of the four flaps,namely,the superficial circumflex iliac artery flap,the superficial inferior epigastric artery flap,the paraumbilical perforator of the deep epigastric artery flap,or the lateral intercostal artery perforator flap was chosen and preexpanded,according to the size and the location of the scar in the upper extremity.At the second stage,after adequate expansion lasting 3 to 4 months,the preexpanded flap was pedicled and transferred to resurface the upper extremity after scar resection.At the last stage,3 weeks later,the pedicle was divided.Results The 12 patients application expansion shaft gets abdominal type flap in 15 cases,3 patients with bilateral the application expansion shaft type abdominal skin flap,flap all survived,not bloated shape,color,texture and surrounding skin close,limb function improved obviously.Conclusion The expansion of abdominal shaft flap is large area of the upper scar tissue repair a very effective method,can obtain appearance and function are the satisfied result;But the treatment cycle is long,the need for the first operation points shortcomings.