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1、中国修复重建外科杂志2007年7月第21卷第7期·707·腋周瘢痕瓣修复腋胸瘢痕粘连李正勇段伟强王怀胜弓晓媛王耀军岑瑛马俊张辉【摘要】目的探讨烧伤患者腋胸瘢痕粘连的修复方法。方法2001年1月～2005年12月,应用腋周瘢痕瓣修复腋胸瘢痕粘连52例(57例次),其中男31例,女21例;年龄1～44岁,中位年龄15岁。采用腋窝后份瘢痕瓣44例次,腋窝前份瘢痕瓣10例次,上臂内侧瘢痕瓣3例次。19例次供瓣区周围皮瓣推进直接缝合,其余38例次行中厚皮片植皮修复。结果术后54例次瘢痕瓣完全成活,伤口É期愈合,
2、3例次瘢痕瓣远端部分坏死,经换药等处理后伤口愈合,且术后获得较好的腋窝形状及肩关节功能。供瓣区直接缝合者伤口均É期愈合,中厚皮片移植者皮片均成活。术后均获随访1个月～5年,患者腋窝形态良好,肩关节活动基本不受限,外展平均150°。结论腋周局部瘢痕瓣是修复腋胸瘢痕粘连、重塑腋窝形状及功能的一种有效途径。【关键词】腋周瘢痕粘连瘢痕瓣修复中图分类号:R619.6R622.1文献标识码:ARECONSTRUCTIONOFSCARCONSTRACTURESINAXILLAANDCHESTWITHLOCALSCA
3、RSKINFLAPöLIZhengyong,DUANWeiqiang,WANGHuaisheng,etal.DepartmentofPlasticSurgery,WestChinaHospital,SichuanUniversity,ChengduSichuan,610041,P.R.China.E2mail:lizhengyong123@hotmail.comCorrespondingauthor:CENYing【Abstract】ObjectiveToinvestigateasuitableway
4、toreconstructscarconstracturesintheaxillaandchest.MethodsFromJanuary2001toDecember2005,52patients(57episodes)withscarconstracturesintheaxillaandchestweretreated,including31malesand21femaleswithanagerangeof1244years.Thedeformitiesofscarconstracturesinthe
5、axillaandchestwerereconstructedwithposteriorpartofaxillaryscarskinflaps(44epidsodes),anteriorpartofaxillaryscarskinflaps(10episodes)andlateralpartofupperarm'sscarskinflaps(3episodes).Theflapsweresuturedtothesurroundingtissuesin19episodes,thedonorsitesin
6、other38caseswerecoveredwithsplitthicknessskingrafts.ResultsFifty2fourscarskinflapssurvivedcompletelybythefirstintentionexcept3flaps,whichmarginnecrosedandhealedwithdressingchanges.Allpatientswerefollowedup1monthto5years.Allpatientsgainedagoodfunctionalr
7、ecoveryandcosmeticappearanceaftertheoperation,andtheunfoldingfunctionofshoulderrestoredto150°.ConclusionAxillarylocalscarskinflapisagoodalternativemethodtoreconstructscarconstracturesintheaxillaandchest.【Keywords】AxillaScarconstractureScarskinflapRepair
8、严重烧伤患者,特别是儿童,常合并腋部烧伤。烧龄1～44岁,中位年龄15岁。5例为双侧瘢痕挛缩。烧伤创面愈合后,瘢痕挛缩常致腋胸瘢痕粘连,使肩关节伤面积15%～80%;烧伤至整复手术时间3个月～14功能受限,对于青春期女性患者,将会影响其乳房发年。检查:瘢痕均位于腋窝周围,质韧,充血,表面无皲育。因此,早期矫治腋胸部畸形,对恢复肩关节功能、促裂、溃疡及局部红、肿、压痛等表现。周围皮肤软组织活进相应组织器官发育尤为重要。由于该类患者腋周正动度差,无残存正常皮
