持续注水快速皮肤软组织扩张术的临床应用

Clinical application of continuous rapid tissue expansion

目的 探讨一种简单易行的持续快速皮肤扩张方法及其临床应用。方法 选择 2 2例瘢痕、色素痣及毛细血管瘤患者 ,Ⅰ期手术在病变内设计垂直小切口埋置扩张器 ,术后第 2天开始用微量推注泵做持续注水扩张。注水结束后 3～ 5d行Ⅱ期手术。结果 共埋置扩张器 35个 ,选择灌注速度为每10 0ml扩张器容量 0 .2～ 0 .8ml/h进行持续注水扩张。平均注水时间 15 .3d ,1例出现切口处扩张器外露 ,1例于Ⅱ期术后出现皮瓣远端部分坏死。经 3个月至 1年的随访 ,效果较满意。结论 采用病变内垂直小切口埋入扩张器 ,并早期应用微量推注泵做持续注水扩张 ,可以最大限度地缩短扩张期时间 ,是一种较理想的快速皮肤扩张法。

Objective To study a simple surgical method for continuous rapid tissue expansion and its clinical application. Methods The operation was accomplished in two-stage procedures. First, expanders were placed in the subcutaneous pocket through interlesional perpendicular short incisions. Continuous expansion by trace syringe pump began from the second day after expander placement. The speed of water injection was set according to patient's algesthesia reaction and vascularity of skin. The second operation was carried out at the third to fifth day after the expansion completed.Results The method was put into clinical practice in 22 cases (16 cases of scar, 2 cases of capillary angioma, and 4 cases of black nevus), and 35 expanders were placed. The speed of water injection was set in 0.2～0.8ml/hr/100ml.The mean time of water injection was 15.3 days. In the process of expansion, all cases were satisfactory except 1 case, in which the expander exposed in the incision. After the second operation, all flaps survived except one showing distal skin necrosis. The result was satisfactory after 3 months to 1 year follow-up. Conclusion The procedure consists of expander placement through interlesional perpendicular short incisions and continuous expansion in advance, which maximally shortens the time of expansion and hospitalization. This expansion method is a simple, safe, reliable, and ideal rapid tissue expansion technique.