马芸　马蕾　邹继军　汪玉霄　涂晶晶

[摘要]目的：探究全厚皮片植皮修復在小儿手部瘢痕整形中的应用效果。方法：回顾性分析2018年1月-2019年11月笔者医院收治的40例手部烧伤后瘢痕挛缩患儿的临床资料，根据手术方式的不同分为植皮组（22例，27只患手）和皮瓣修复组（18例，18只患手）。观察移植皮片/皮瓣成活情况，记录创面愈合时间、并发症发生率、术后疼痛情况、手部功能及形态恢复情况。结果：所有患儿均顺利完成手术。术后2周，植皮组25只患手移植皮片全部存活;1只出现伤口感染;2只出现再次瘢痕挛缩，行二次瘢痕切除植皮治疗。皮瓣修复组18只患手术后皮瓣全部成活，除2只出现伤口感染，无其他并发症发生。植皮组创面愈合时间及WBFS评分均低于皮瓣修复组，手部功能恢复优良率高于皮瓣修复组，差异均有统计学意义（P<0.05）。结论：全厚皮片植皮术在小儿手部瘢痕整形中应用价值较高，术后皮片成活率高，能有效改善患儿手部挛缩，促进手功能恢复。

[关键词]瘢痕畸形;整形修复;烧伤;全厚皮片植皮术;瘢痕切除术

[中图分类号]R619+.6    [文献标志码]A    [文章编号]1008-6455（2021）09-0048-03

Application of Full Thickness Skin Graft in the Plastic Surgery for Children with Hand Scars

MA Yun，MA Lei，ZOU Ji-jun，WANG Yu-xiao，TU Jing-jing

（Department of Burns and Plastic Surgery，Children's Hospital of Nanjing Medical University，Nanjing 210000，Jiangsu，China）

Abstract： Objective  To explore the effect of full-thickness skin graft in the plastic surgery of hand scar in children. Methods  Clinical data of 40 children with scar contracture after burns who were treated at the hospital hospital during the period from January 2018 to November 2019 were retrospectively analyzed. The children were divided into the skin graft group （22 cases， 27 hands） and the flap repair group （18 cases， 18 hands） according to the surgical method. The survival status of skin grafts/flaps was observed. Wound healing time， the incidence of complications， postoperative pain， hand function and morphological recovery were recorded. Results  All children underwent successful surgery. Two weeks after operation， all the grafts of 25 hands in the skin grafting group survived. One had wound infection. Two hands had scar contracture again and were treated with secondary scar resection and skin grafting. In the flap repair group， all 18 flaps survived after operation， and there were no other complications except two hands wound infection. The wound healing time and WBFS score in the skin graft group were lower than those in the flap repair group， and the excellent and good rate of hand function recovery was higher than that in the flap repair group， the differences were statistically significant（P<0.05）. Conclusion  Applying full thick skin graft in plastic surgery for children with hand scars can not only achieve high survival rate of skin flaps but also effectively relieve hand contracture and promote hand function recovery.

Key words： scar deformity; plastic repair; burn; full thickness skin grafting; scar excision

由于小儿自理能力较差，对外部环境缺乏判断，其发生烧伤或烫伤的比例高居儿童伤害前列[1-2]。小儿手部皮肤角质层较薄，当烧伤深度达深Ⅱ度及以上时，极易留下瘢痕，若未及时修复受损皮肤和软组织，则会因皮肤纤维无序增生而产生瘢痕挛缩[3-4]。瘢痕及瘢痕挛缩的产生不仅会对患儿的心理健康、人际交往等产生影响，而且会严重影响患儿的肢体功能。因此，尽早地采取治疗十分重要。手术修复是治疗手部烧伤瘢痕挛缩的有效方法之一，常用的整形手术方式主要包括瘢痕切除植皮术与瘢痕切除皮瓣修复术[5]。……