皮肤软组织扩张器植入术后并发扩张囊部分外露的成功修复:病例报道2例

Successful repair of skin tissue expansion devices implantation with partial exposure of dilated sac:Two cases report

2023年9月至2023年12月收治的2例烧伤后瘢痕患者,Ⅰ期植入皮肤软组织扩张器,术后并发扩张球囊部分外露,其中一例外露面积约为5 cm×5 cm,容积约为50 mL,占注水总量的20%;另一例外露面积约为3 cm×2 cm,容积约为20 mL,占注水总量的5%。分析扩张器球囊外露原因,给予换药,同时扩张器内注水并加压包扎,挽救外露的扩张球囊。最终成功注水270 mL和360 mL,约占皮肤软组织扩张器额定容量的67%和90%。术后2例患者瘢痕修复效果良好,扩张皮瓣未见坏死,无运动及感觉功能障碍,患者满意。分析皮肤软组织扩张器植入后扩张球囊部分外露的原因如下:①瘢痕的扩张有限,周围条件不充分时,创口极易裂开;②电凝时间过长导致皮瓣局部全层坏死,易导致扩张器外露。总结此类并发症的治疗经验:防治感染,外加包扎与固定,减轻局部外露球囊的张力。此外,负压封闭引流可促进创面愈合。

From September 2023 to December 2023,two patients with burn scar formation were admitted.The skin and soft tissue expander was implanted in stage I,and part of the expander balloon was exposed after surgery.In one case,the exposed area was about 5 cm×5 cm and the volume was about 50 mL,accounting for 20%of the total water injection.The exposed area of the other case is about 3 cm×2 cm,and the volume is about 20 mL,accounting for 5%of the total water injection.The causes of the exposed expander balloon were analyzed,and dressing change was given.At the same time,water injection and pressure bandaging were used to save the exposed expander balloon.In the end,270 mL and 360 mL water were successfully injected,accounting for about 67%and 90%of the rated capacity of the skin soft tissue expander.Postoperative scar repair results were good in 2 patients,no necrosis of expanded flap,no motor and sensory dysfunction,and the patients were satisfied.The reasons for the partial exposure of the expansion balloon after the implantation of the skin and soft tissue expander are as follows:1.Scar expansion is limited and the surrounding conditions are not sufficient,and the wound is easy to split;2.Too long electric coagulation time leads to local full-layer necrosis of the flap,which easily leads to the exposure of the expander.The experience in the treatment of such complications:prevention and treatment of infection,external bandaging and fixation to reduce the tension of local exposed balloon.In addition,negative pressure closure and drainage can promote wound healing.