CAJ | 학술논문

目的：探索烧创伤毁损性创面在修复创面的同时早期功能重建与外形修复的方法。方法对2004年3月至2013年12月山西医科大学附属太钢总医院收治的97例各种原因导致的毁损性创面患者，在注重早期清创及创面处理质量基础上，运用美容美学理念、应用整形外科原则和技术，周密设计手术方案，皮瓣转移时，同期行肌腱移植等深部组织修复；应用游离、带蒂皮（肌）瓣中的筋膜、肌肉组织进行缺损区韧带、肌肉修复并封闭创面，利用预构皮瓣及复合组织移植再造缺损区功能及外形，早期邻近软组织预扩张技术一期修复软组织缺损骨外露及器官再造。结果97例患者，其中一期清创后行局部皮瓣、轴型皮瓣、游离组织瓣修复17例。另清创后行封闭负压引流，应用带蒂、游离组织瓣预制、延期器官再造、功能重建80例，其中，肌腱移植＋皮瓣移植11例；神经吻合3例，神经移植3例；利用组织瓣筋膜、肌腱修复髌韧带7例、修复半侧颜面毁损后鼻再造1例；早期软组织扩张皮瓣预置扩张修复骨缺损、外露及创伤性秃发19例；复合组织瓣预制唇龈沟重建，下颌缺损修复5例；热压伤分指袋状皮瓣保指术6例；阴囊／肛门修复再造4例；足跟踝部组织瓣修复21例，所有患者治疗后均达到保留和重建局部功能、外观较满意的修复效果。结论贯彻整形美容理念，“前移”整形外科手段，结合各种创面处理措施，是实现部分毁损性创面早期功能重建及外形修复的理想方法。
목적：탐색소창상훼손성창면재수복창면적동시조기공능중건여외형수복적방법。방법대2004년3월지2013년12월산서의과대학부속태강총의원수치적97례각충원인도치적훼손성창면환자，재주중조기청창급창면처리질량기출상，운용미용미학이념、응용정형외과원칙화기술，주밀설계수술방안，피판전이시，동기행기건이식등심부조직수복；응용유리、대체피（기）판중적근막、기육조직진행결손구인대、기육수복병봉폐창면，이용예구피판급복합조직이식재조결손구공능급외형，조기린근연조직예확장기술일기수복연조직결손골외로급기관재조。결과97례환자，기중일기청창후행국부피판、축형피판、유리조직판수복17례。령청창후행봉폐부압인류，응용대체、유리조직판예제、연기기관재조、공능중건80례，기중，기건이식＋피판이식11례；신경문합3례，신경이식3례；이용조직판근막、기건수복빈인대7례、수복반측안면훼손후비재조1례；조기연조직확장피판예치확장수복골결손、외로급창상성독발19례；복합조직판예제진간구중건，하합결손수복5례；열압상분지대상피판보지술6례；음낭／항문수복재조4례；족근과부조직판수복21례，소유환자치료후균체도보류화중건국부공능、외관교만의적수복효과。결론관철정형미용이념，“전이”정형외과수단，결합각충창면처리조시，시실현부분훼손성창면조기공능중건급외형수복적이상방법。
Objective To explore the damage to the wound in repairing the at the same time,early functional reconstruction of the wound and shape repair methods.Methods Ninty-seven cases of damaged wounds admitted to General Hospital of Tisco,Shanxi Medical University from Mar.2004 to Dec.201 3, caused by all sorts of reasons,on the basis of paying more attention to early debridement and wound treatment quality,using cosmetic aesthetic concept,application principle and technology,plastic surgery careful design operation plan and flap transfer,at the same time tendon transplantation,etc of deep tissue repair.Application free,(muscle)pedicle skin flap of the fascia and muscle tissue defect,muscle ligament repair and closed wound,using pre constitutive flap and composite tissue transplants defect function and shape,early adjacent soft tissue expansion in advance technical issue to repair soft tissue defects of bone exposed and reproductive organs.Results Ninty-seven patients,the issue of local flap,axial flap debridement was retreating,free tissue flap to repair of 1 7 cases.Debridement after seal negative pressure drainage,the application of pedicle,free tissue flap prefabricated,delay the reproductive organs,functional reconstruction in 80 cases,among them,the tendon transplantation +skin flap transplantation in 1 1 cases. Nerve anastomosis (3 cases),nerve transplantation (3 cases).Using tissue flap fascia,tendon repair patellar ligament in 7 cases,repair the damaged side face after nasal reconstruction in 1 case.Early soft tissue preset expansion expansion flap to repair bone defect,the leakage and 1 9 cases traumatic bald. Composite tissue flap prefabricated labial gingival groove reconstruction,5 cases of mandibular defect. Thermal injury refers to the pocket flap insurance refers to the operation 6 cases.Scrotal/anal repair reengineering 4 cases.Heel ankle tissue flap to repair 21 cases,all patients after treatment to reach the local function,appearance and reconstruction satisfactory repairing effect.Conclusion To carry out cosmetic surgery concept,“forward”plastic surgery method,combined with a variety of wound treatment,is the ideal method to realize of partial damage early functional reconstruction and shape of the wound.