文献类型：期刊文献

中文题名：穿支皮瓣整复严重烧伤患者四肢大关节部位瘢痕增生挛缩畸形的效果

英文题名：Effects of perforator flaps in the reconstruction of hypertrophic scar contracture deformities in the large joints of extremities of patients after severe burns

作者：胡骁骅[1];覃凤均[1];李娟[2];马春旭[1];沈余明[1]

第一作者：胡骁骅

机构：[1]北京积水潭医院烧伤科,100035;[2]甘肃中医药大学附属医院急诊科,兰州730000

第一机构：北京积水潭医院烧伤科,100035

年份：2019

卷号：35

期号：6

起止页码：417

中文期刊名：中华烧伤杂志

外文期刊名：Chinese Journal of Burns

收录：CSTPCD;;Scopus;北大核心:【北大核心2017】；CSCD:【CSCD2019_2020】；PubMed;

语种：中文

中文关键词：烧伤;瘢痕;四肢;关节;穿支皮瓣

外文关键词：Burns;Cicatrix;Extremities;Joints;Perforator flaps

摘要：目的探讨应用穿支皮瓣整复严重烧伤后四肢大关节部位瘢痕增生挛缩畸形的临床效果。方法2008年1月—2018年1月,北京积水潭医院烧伤科收治严重烧伤后四肢大关节部位瘢痕增生挛缩畸形伴功能障碍患者72例,其中男53例、女19例,年龄5~63岁,累及肩关节28例、肘关节15例、髋关节7例、膝关节17例、踝关节5例。本组患者瘢痕切除松解后创面面积为7cm×6cm^34cm×12cm,根据关节部位、软组织条件等情况分别采用相应的未经扩张的穿支皮瓣或扩张后穿支皮瓣修复,本组患者皮瓣切取面积为7cm×6cm^35cm×14cm。供瓣区中51例直接拉拢缝合,21例采用断层皮或网状皮修复。记录本组患者所用手术方式、术后皮瓣存活情况及随访时各关节功能恢复情况。结果本组患者中53例行单纯穿支皮瓣修复术,19例行穿支皮瓣修复+皮片移植术;其中,扩张后穿支皮瓣12例、未经扩张穿支皮瓣60例,穿支皮瓣游离移植9例、带蒂移植61例、交腹股沟移植2例。最终67个皮瓣完全成活;5个皮瓣远端坏死,经换药或清创植皮后愈合。随访6个月~3年,所有患者关节功能明显改善,肩关节外展角度为110°以上,髋、膝、肘关节均能达到伸直位且屈曲正常,足下垂畸形矫正;皮瓣外形良好,并较原始状态有明显的伸展。结论穿支皮瓣适用于整复严重烧伤患者四肢大关节部位瘢痕增生挛缩畸形,在修复创面的同时,能使关节功能得到最大限度的恢复。
Objective To explore the clinical effects of perforator flaps in the reconstruction of hypertrophic scar contracture deformities in the large joints of extremities after severe burns.Methods From January 2008 to January 2018,72 patients(53 males and 19 females,aged 5 to 63 years)with hypertrophic scar contracture deformities and functional disorder in the large joints of extremities after severe burns were admitted to the Department of Burns of Beijing Jishuitan Hospital.Scar hyperplasia and contracture deformity were located at shoulder joints of 28 patients,elbow joints of 15 patients,hip joints of 7 patients,knee joints of 17 patients,and ankle joints of 5 patients.The wound area of patients after the scars were excised and released ranged from 7 cm×6 cm to 34 cm×12 cm.The wounds were repaired with corresponding unexpanded perforator flaps or expanded perforator flaps according to the joint location and existing soft tissue conditions.The size of flaps ranged from 7 cm×6 cm to 35 cm×14 cm.The donor sites of 51 patients were sutured directly;the donor sites of 21 patients were repaired by segmented grafts or mesh grafts.The adopted surgeries,the survival of flaps after surgery,and the functional recovery of the joints during follow-up were recorded.Results Among the 72 patients,53 patients had perforator flap repairing surgery only;19 patients had perforator flap repairing surgery and skin grafting.Among them,12 patients had expanded perforator flaps,60 patients had unexpanded perforator flaps.The perforator flaps were performed free transplantation in 9 patients,pedicled transplantation in 61 patients,and groin transplantation in 2 patients.At last,67 flaps survived completely,while 5 flaps had distal-end necrosis which were healed after dressing change or skin grafting after debridement.During follow-up of 6 months to 3 years,the joint function of all the patients was obviously improved.The abduction angles of shoulder joints were over 110°;the hip,knee,and elbow joints could reach the straight position,and the flexion was normal;the foot drop deformity was corrected,and the appearance of flaps was good with obvious extension compared with the original state.Conclusions Perforator flaps are suitable for reconstruction of hypertrophic scar contracture deformities in the large joints of extremities of patients after severe burns.They can restore the joint function to the greatest extent as well as repair the wounds.