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[烧伤后腋窝瘢痕挛缩畸形的治疗]

[The treatment of deformity of axillary scar contracture after burns].

作者信息

Chai Jia-ke, Song Hui-feng, Chen Min-liang, Chen Bao-ju, Jing Sa, Xu Ming-huo, Wu Yan-qiu, Zhou Ning

机构信息

Department of Burn and Plastic Surgery, 304th Hospital of PLA, Beijing 100037, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2004 May 17;84(10):830-2.

Abstract

OBJECTIVE

To explore the best methods to repair the deformity of axillary scar contracture after burns.

METHODS

Ninety cases in 78 patients with axillary scar contracture after burns from January 1998 to January 2002 were analyzed. According to the severity of the deformity and its influence on the function of the shoulder joint. 46 cases suffered from mild degree axillary scar contracture, 26 cases with moderate and 18 with severe degree. The deformities of axillary scar contracture were repaired by Z plasty (18 cases), five-flap plasty (14 cases), skin graft (23 cases), Z plasty and skin graft (14 cases), transfer of scapular skin flaps (5 cases), lateral throatic skin flaps (4 cases) and scar flaps (12 cases), respectively. Exopexy, anti-scar drug and functional exercises were applied postoperationally.

RESULTS

All the flaps were survived with first intention, except for necrosis of the split skin graft occurring in 4 cases. The function and configuration in all the cases were satisfactory after 6 months to 4 years follow-up.

CONCLUSION

Appropriate methods should be chosen to restore the function and configuration of the shoulder joint and improve patients' living condition according to the size, degree of the deformity of axillary scar contracture after burns.

摘要

目的

探讨修复烧伤后腋窝瘢痕挛缩畸形的最佳方法。

方法

对1998年1月至2002年1月收治的78例烧伤后腋窝瘢痕挛缩患者中的90例进行分析。根据畸形严重程度及其对肩关节功能的影响,轻度腋窝瘢痕挛缩46例,中度26例,重度18例。分别采用Z成形术(18例)、五瓣成形术(14例)、植皮术(23例)、Z成形术联合植皮术(14例)、肩胛皮瓣转移术(5例)、胸外侧皮瓣转移术(4例)及瘢痕皮瓣转移术(12例)修复腋窝瘢痕挛缩畸形。术后进行外固定、抗瘢痕药物治疗及功能锻炼。

结果

除4例中厚皮片移植后出现坏死外,其余皮瓣均一期成活。经6个月至4年随访,所有病例功能及外形均满意。

结论

应根据烧伤后腋窝瘢痕挛缩畸形的大小、程度选择合适的方法,以恢复肩关节功能及外形,改善患者生活质量。

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