吻合血管扩张皮瓣修复大面积烧伤患者瘢痕挛缩畸形美容效果研究

Cosmetic effect of expanded skin flap with vascular anastomosis in repair of scar contracture deformity in patients with extensive burns

目的:分析吻合血管扩张皮瓣修复大面积烧伤患者瘢痕挛缩畸形的美容效果。方法:收集80例大面积烧伤所致瘢痕挛缩畸形患者的临床资料,根据治疗方式分为吻合血管的扩张皮瓣修复组(吻合组,n=46)与未吻合血管的扩张皮瓣修复组(未吻合组,n=34)。比较两组患者围术期指标(手术时间、住院时间、术后1个月内二次住院发生率)、皮瓣成活情况、并发症与瘢痕挛缩复发情况、美容效果满意度。结果:吻合组平均手术时间长于未吻合组(P<0.05),住院时间短于未吻合组(P<0.05),术后1个月内二次住院发生率低于未吻合组(P<0.05);吻合组皮瓣成活率高于未吻合组(P<0.05);吻合组术后1年内瘢痕挛缩复发率、皮瓣远端静脉瘀血发生率均低于未吻合组(均P<0.05);吻合组美容效果总满意度高于未吻合组(P<0.05)。结论:吻合血管扩张皮瓣修复大面积烧伤后瘢痕挛缩畸形疗效满意,可预防术后皮瓣静脉瘀血或坏死,减少瘢痕挛缩复发,美容效果理想,患者满意度高。

Objective:To analyze the cosmetic effect of expanded skin flap with vascular anastomosis in the repair of scar contracture deformity in patients with extensive burns.Methods:The clinical data of 80 patients with scar contracture deformity caused by extensive burns were collected.According to the treatment methods,the patients were divided into expanded skin flap repair with vascular anastomosis group(anastomosis group,46 cases)and expanded flap repair without vascular anastomosis group(non-anastomosis group,34 cases).The perioperative indicators(surgical time,hospital stay,incidence rate of secondary hospitalization within 1 month after surgery),skin flap survival status,complication,recurrence of scar contracture and cosmetic effect satisfaction were compared between the two groups.Results:The average surgical time in the anastomosis group was longer than that in the non-anastomosis group,and the hospital stay was shorter than that in the non-anastomosis group,and the incidence rate of secondary hospitalization within 1 month after surgery was lower than that in the non-anastomosis group(all P<0.05).The skin flap survival rate in the anastomosis group was higher than that in the non-anastomosis group(P<0.05).The recurrence rate of scar contracture and the incidence rate of distal venous blood stasis of skin flap within 1 year after surgery in the anastomosis group were lower than those in the non-anastomosis group(all P<0.05).The total satisfaction of cosmetic effect in the anastomosis group was higher than that in the non-anastomosis group(P<0.05).Conclusion:Expanded skin flap with vascular anastomosis has a satisfactory efficacy in repairing scar contracture deformity after extensive burns.It can prevent the postoperative venous blood stasis or necrosis of skin flap,and reduce the recurrence of scar contracture,with ideal cosmetic effect and high patient satisfaction.