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目的探讨皮下蒂旋转瘢痕瓣修复颈部带状瘢痕挛缩的手术方法及疗效。方法 2008年8月-2010年5月,收治15例烧伤及烫伤后颈部带状瘢痕挛缩患者。男9例,女6例;年龄7～35岁,平均17.3岁。瘢痕形成时间1～8年,平均3年。瘢痕部位:左侧颈部6例,右侧颈部8例,颏颈角区1例。瘢痕挛缩程度按黎鳌烧伤治疗学的分类标准:Ⅰ度12例,Ⅱ度3例。瘢痕范围8cm×5cm～25cm×12cm。采用大小为7cm×5cm～15cm×10cm的皮下蒂旋转瘢痕瓣修复瘢痕松解后创面,其中3例Ⅱ度颈部瘢痕挛缩患者同时于瘢痕瓣下方颈根部以大小为7cm×4cm～12cm×7cm腹部中厚皮片游离移植修复。结果术后2周2例瘢痕瓣远端出现部分表皮坏死,经换药后愈合,并有轻度增生性瘢痕形成;其余瘢痕瓣及植皮均顺利成活,切口均Ⅰ期愈合。术后患者均获随访,随访时间6～12个月。瘢痕松解彻底,颌颈角及颏颈角恢复正常,瘢痕瓣与周围皮肤颜色接近,无再次挛缩发生。末次随访时颈部活动范围恢复正常。结论皮下蒂旋转瘢痕瓣可有效修复颈部带状瘢痕挛缩,能充分利用侧方多余瘢痕修复纵向瘢痕挛缩所致的皮肤缺损。
Objective To investigate the surgical method and curative effect of revolving scars flap with subcutaneous pedicle to repair the cervical scar contracture. Methods From August 2008 to May 2010, 15 patients with cervical scar contracture after burn and scald were treated. 9 males and 6 females; aged 7 to 35 years, mean 17.3 years old. Scar formation time of 1 to 8 years, an average of 3 years. Scar site: left neck in 6 cases, right neck in 8 cases, 1 case of genital neck angle. The degree of scar contracture according to the classification criteria of AoA burn treatment: Ⅰ degree in 12 cases, Ⅱ degree in 3 cases. Scar range of 8cm × 5cm ~ 25cm × 12cm. The scaled skin flap was repaired by subcutaneous pedicle screw scars of 7cm × 5cm ~ 15cm × 10cm in size. Three patients with grade Ⅱ cervical scar contracture were treated at the cervical root below the scar flap with the size of 7cm × 4cm ~ 12cm × 7cm Abdominal thick skin graft free graft repair. Results Two cases of scar flap had partial epidermal necrosis at 2 weeks after operation, healed by dressing change and mild hypertrophic scar formation. The remaining scar flap and skin grafting survived smoothly, and incisions healed in the first stage. Postoperative patients were followed up for 6 to 12 months. Complete release of scar, neck and neck neck angle returned to normal, the scar flap and the surrounding skin color close, no recurrence of contracture. Neck movement range returned to normal at the last follow-up. Conclusion The subcutaneous pedicle screw flap can effectively repair the cervical scar contracture and can make full use of the excess scar on the lateral side to repair the skin defect caused by the longitudinal scar contracture.