【作者】 徐法伟；

【导师】 张舵；

【作者基本信息】 吉林大学 ， 临床医学， 2009， 硕士

【摘要】 我院整形外科于2006年3月至2009年3月间收治了15例利用两个及以上扩张器来修复切除巨痣和较大面积瘢痕后形成的皮肤缺损的患者,通过对该组患者治疗过程和修复结果的深入研究,总结多个扩张器植入术的切口设计和并发症预防方面的经验。该组患者所修复的皮肤缺损面积最小为4.5cm×2.0cm,最大面积达19cm×21cm。所有病例均采用两个或以上扩张器进行手术治疗,术前认真设计手术方案,术中规范操作,冷光源直视下彻底止血,术后精心护理,注液扩张有序进行。结果除1例患者因扩张器外露严重导致部分瘢痕未能被修复外,所有患者拟修复的皮肤缺损区域均得到有效修复,随访1~12个月,所有患者修复区皮肤色泽、质地及功能良好,供区损伤小,修复效果较为满意。通过该研究我们可得出下述结论:相邻的扩张器埋植尽量选用同一切口,既减少了创伤又为二期皮瓣转移留有更大的余地;垂直于扩张囊的切口在扩张后期更不易裂开。应用冷光源直视下止血是预防血肿的重要措施;采用“栅栏”缝合、相邻扩张器注水速度协调一致能有效预防扩张器外露。更多还原

【Abstract】 Objective:The purpose of this study is to research the incision design and the complication prevention of the multi-expanders implantation.Methods:Fifteen patients (7 males and 8 females) with ages ranging from 5 to 51, consecutively, with large defects of the skin between March of 2006 and March of 2009 are included in this study. The reasons resulted to the large defects of the skin of these patients are as follows:①t he resection of the giant nevus②the treating of large scar.We treated them by skin soft-tissue expansion with two or more expanders. The minimum area of the skin defect was 4.5cm×2.0cm,and the largest area of the skin defect was 19cm×21cm.Preoperative photographs should be taken.Before the operation, the position of the expanders and the incision lines were marked out with methylene blue. Cavities of suitable size were formed mainly by dissecting the skin-soft tissue. Make sure any living bleeding was stopped by using the gauze or electric coagulation. Insert the negative pressure drainage before inserting the expanders. Close the incision finally.The second step was injecting the normal saline time by time into the expander to make the skin-soft tissue expanded.This phase might last for several months until enough skin was produced.The last important procedure was to take out the expanders and repair the skin defects according to skin flaps transfering.Results:All the patients who received the skin soft-tissue expansion with two or more expanders had perfect results except one patient. Most patients were satisfied with the flap’s color and luster,and also the regional function. The rates of the complication happening were not very high,but still higher than it in the single expander skin soft-tissue expansion.Conclusions:1. We can use one incision for the adjacent expanders; the incision which is perpendicular with the expanders is better.2. To stop bleeding by using the cold light source and to use grating suture can prevent complication effectively.更多还原