CAJ | 학술논문

目的探讨扩张皮瓣治疗头皮大面积增生性瘢痕的临床效果.方法 2011年6月至2013年4月,共收治头皮大面积增生性瘢痕患者23例,瘢痕面积最大17.5 cm×9.5 cm,最小5.5 cm×4.0 cm.共埋置31个扩张器,扩张器容量50～400 ml.视瘢痕形状选择肾形或椭圆形扩张器.经6～8周注水扩张后,行增生性瘢痕切除、扩张器取出和扩张皮瓣转移术.术后行放射性核素局部照射治疗,随访6～12个月.结果除1个扩张器瘢痕下埋置后因感染而提前取出外,余30个扩张器均顺利完成整个治疗过程.主要并发症为扩张器外露4个,但未影响Ⅱ期手术.除3例复发外,其余20例自觉症状均明显缓解,效果满意.3例复发患者均为扩张不满意,缝合时切口张力较大,且术后延期拆线.结论扩张皮瓣是治疗头皮大面积增生性瘢痕较为理想的方法.切口缝合张力大小是术后瘢痕是否复发的关键.
목적 탐토확장피판치료두피대면적증생성반흔적림상효과.방법 2011년6월지2013년4월,공수치두피대면적증생성반흔환자23례,반흔면적최대17.5 cm×9.5 cm,최소5.5 cm×4.0 cm.공매치31개확장기,확장기용량50～400 ml.시반흔형상선택신형혹타원형확장기.경6～8주주수확장후,행증생성반흔절제、확장기취출화확장피판전이술.술후행방사성핵소국부조사치료,수방6～12개월.결과 제1개확장기반흔하매치후인감염이제전취출외,여30개확장기균순리완성정개치료과정.주요병발증위확장기외로4개,단미영향Ⅱ기수술.제3례복발외,기여20례자각증상균명현완해,효과만의.3례복발환자균위확장불만의,봉합시절구장력교대,차술후연기탁선.결론 확장피판시치료두피대면적증생성반흔교위이상적방법.절구봉합장력대소시술후반흔시부복발적관건.
Objective To observe the efficacy and safety of implantation of tissue expanders for large hyperplastic scar on scalp.Methods Between June 2011 and April 2013,a total of 23 patients with large hyperplastic scar received treatment with 31 tissue expanders.The scar size varied from 5.5 cm × 4.0 cm to 17.5 cm ×9.5 cm.The capacity was 50-400 ml for expanders,with the shape of kidney or ellipse.After tissue expansion for 6 to 8 weeks,the expander was removed and hyperplastic scars were resected,followed by the repair of defect with expanded flaps.Further more,the patients received postoperative superficial isotope irradiation after the surgery.Follow-up varied from 6 to 12 months.Results Thirty expanders,except l expander pocket that was removed ahead of time due to infection,were implanted successfully during the whole course of treatment.The main complication was expander exposure in 4 patients,which showed no significant influence on secondary surgery.Twenty patients reported relief of symptoms and achieved satisfactory outcomes,while 3 patients showed great suture tension and experienced delayed stitch removal,followed by the recurrence of hyperplastic scar after the operation.Conclusions The implantation of tissue expanders under the scalp skin is an ideal treatment option for large hyperplastic scar on scalp.Regional suture tension is a direct contributor to the recurrence of hyperplastic scar formation after surgical excision.