CAJ | 학술논문

目的探讨颈部烧伤后瘢痕挛缩畸形的手术策略. 方法 2013年7月-2014年7月,笔者单位收治65例颈部烧伤后瘕痕挛缩患者.按颈部下唇唇红缘-颌上区、颌下区、颈前区3个解剖学亚单位的不同要求,对颈部挛缩瘢痕进行相应松解,后行颈阔肌松解术,部分颏部发育短小患者行水平截骨颏成形术.依据覆盖颈部创面的皮肤组织与创周皮肤组织的色泽、质地、厚度等尽可能接近的相似性原则,除学龄前患儿行皮片移植外,根据患者情况分别采用局部皮瓣、邻位皮瓣或游离皮瓣修复创面. 结果所有患者均行瘢痕松解及颈阔肌松解术;9例患者行水平截骨颏成形术;32例患者采用局部扩张皮瓣,7例患者采用邻位皮瓣,11例患者采用游离皮瓣,15例患者采用皮片.术后所有皮片、皮瓣均成活,所有患者术后颈部活动良好,重建后的颏颈角角度为90～ 120°.随访6～ 24个月,6例植皮患者出现一定程度的皮片挛缩,采用皮瓣修复的患者均未见挛缩现象. 结论颈部瘢痕挛缩畸形的治疗以颏颈角重建为重点,依据亚单位原则松解挛缩瘢痕,依据相似性原则修复创面,优先采用皮瓣移植术,次选植皮术,可取得较佳修复效果.
목적 탐토경부소상후반흔련축기형적수술책략. 방법 2013년7월-2014년7월,필자단위수치65례경부소상후하흔련축환자.안경부하진진홍연-합상구、합하구、경전구3개해부학아단위적불동요구,대경부련축반흔진행상응송해,후행경활기송해술,부분해부발육단소환자행수평절골해성형술.의거복개경부창면적피부조직여창주피부조직적색택、질지、후도등진가능접근적상사성원칙,제학령전환인행피편이식외,근거환자정황분별채용국부피판、린위피판혹유리피판수복창면. 결과 소유환자균행반흔송해급경활기송해술;9례환자행수평절골해성형술;32례환자채용국부확장피판,7례환자채용린위피판,11례환자채용유리피판,15례환자채용피편.술후소유피편、피판균성활,소유환자술후경부활동량호,중건후적해경각각도위90～ 120°.수방6～ 24개월,6례식피환자출현일정정도적피편련축,채용피판수복적환자균미견련축현상. 결론 경부반흔련축기형적치료이해경각중건위중점,의거아단위원칙송해련축반흔,의거상사성원칙수복창면,우선채용피판이식술,차선식피술,가취득교가수복효과.
Objective To explore the surgical strategy for postburn cervical scar contracture.Methods Sixty-five patients with scar contracture as a result of burn injury in the neck were hospitalized from July 2013 to July 2014.Release of cervical scar contracture was conducted according to different demands of the 3 anatomic subunits of neck,i.e.lower lip vermilion border-supramaxillary region,submaxillary region,and anterior region of neck.After release of contracture,platysma was released.For some cases with chin retrusion,genioplasty with horizontal osteotomy was performed.The coverage of wound followed the principle of similarity,i.e.the skin tissue covering the wound in the neck should be similar to the characters of skin around the wound in terms of color,texture,and thickness.Based on this principle,except for the preschool children in whom skin grafting was performed,the wounds of the other patients were covered by local skin flaps,adjacent skin flaps,or free skin flaps.Results All patients underwent release of scar and platysma,while 9 patients underwent genioplasty with horizontal osteotomy.Wounds were covered with local skin flaps in 32 patients,with adjacent skin flaps in 7 patients,with free skin flaps in 11 patients,and with skin grafts in 15 patients.All skin grafts and flaps survived.Good range of motion was achieved in the neck of all patients,with the cervicomental angle after reconstruction ranging from 90 to 120°.All patients were followed up for 6 to 24 months.Six patients who had undergone skin grafting were found to have some degrees of skin contracture,while none of the patients who had undergone flap coverage showed any signs of contracture recurrence.Conclusions Restoration of the cervicomental angle is critical in the treatment of postburn cervical scar contracture,and the release of scar contracture should conform to the subunit principle.The coverage of wound should be based on the principle of similarity,with repair by skin flaps as the first choice,and skin grafting as the second choice.Satisfactory effect of repair would be achieved by following the above surgical principles.