袁家德 孙丽双 柯家祥 李宁 朱志军 边曦

[摘要]目的：探讨应用背部扩张表浅瘢痕皮片移植修复特重度烧伤后关节部位瘢痕挛缩畸形效果。方法：选择背部有大片表浅瘢痕，四肢有瘢痕增生挛缩的特重度烧伤后患者6例。一期手术将扩张器置入背部表浅瘢痕处，按照每植皮1cm2注水7～9ml的比例注水扩张背部表浅瘢痕;二期取出扩张器，切取扩张的瘢痕皮片，去除纤维囊层后游离移植到瘢痕挛缩松解的继发创面。结果：所移植的扩张瘢痕皮片有4例完全成活，2例大部分成活，畸形改善明显，关节功能基本恢复。结论：该方法在自体皮源欠缺的情况下，充分利用表浅瘢痕皮片修复瘢痕畸形、重建关节功能，为特重度烧伤后瘢痕挛缩畸形的修复提供了一种安全有效的手术方法。

[关键词]瘢痕;挛缩畸形;皮肤软组织扩张术;扩张瘢痕皮片;关节部位;烧伤;移植修复

[中图分类号]R619+.6    [文献标志码]A    [文章编号]1008-6455（2021）05-0038-03

Repair of Joint Scar Contracture Deformity with Expanded Scar Skin Graft

YUAN Jia-de，SUN Li-shuang，KE Jia-xiang，LI Ning，ZHU Zhi-jun，BIAN Xi

（Department of Burn and Plastic Surgery，Qingdao Municipal Hospital，Qingdao 266011，Shandong，China）

Abstract： Objective  To explore the application of dilated superficial scars on the back to treat scar contractures in the joints after severe burns. Methods  Six patients with severe burns with large superficial scars on the back and scar hyperplasia contractures on the extremities were selected. In the first stage of operation， the dilator was placed into the superficial scar of the back， and the superficial scar of the back was expanded by injecting 7-9ml of water per 1cm2 of skin graft. At the second stage， the dilator was removed， the expanded scar skin was cut， and the fibrous capsule was removed and then the free graft was carried to the secondary wound surface of the loosened scar contracture of the limbs. Results  4 cases of the expanded scar skin graft survived completely， 2 cases mostly survived. The deformity improved obviously， and the joint function basically recovered. Conclusion  This method fully utilizes superficial scar skin to repair scar deformity and reconstruct joint function in the case of scarce autogenous skin source， and provides a safe and effective surgical method for scar repair in patients with severe burn.

Key words： scar; contracture deformity; skin and soft tissue expansion; expanded scar skin graft; joint site; burn; transplantation repair

特重度燒伤患者治愈后多会遗留轻重不一的瘢痕畸形，特别是在肢体关节、面颈部等重要功能部位的瘢痕挛缩畸形，严重影响患者的工作及生活。由于特重度烧伤患者治愈后体表大部分是创面愈合后形成的瘢痕，没有理想的供皮区，更难以提供充裕的皮瓣组织，使整形手术受到很大的限制[1]，这一直是困扰整形医生的难题。本次采取背部扩张表浅性瘢痕皮肤方法获取瘢痕皮片，行瘢痕皮片游离移植治疗特重度烧伤后关节部位瘢痕挛缩，取得了满意效果。……