Tsoutsos Dimosthenis, Stratigos Alexandros, Gravvanis Andreas, Zapandioti Polexini, Kakagia Despoina
Department of Plastic Reconstructive Surgery, Athens General Hospital "G. Gennimatas," Athens, Greece.
J Burn Care Res. 2007 May-Jun;28(3):530-2. doi: 10.1097/BCR.0B013E318053DAC5.
Full-thickness anterior chest wall burns result in contractures that may restrict the development of breast in young female patients. The management of postburn contractured anterior chest wall scars and unilateral breast hypoplasia with the expansion of bilayered artificial skin is herein presented for the first time in literature to the best of our knowledge. A 21-year-old female with chest wall contractures after thermal injury she had suffered at the age of 27 months was managed in three stages. The first stage included release and excision of contractures and scars, submuscular insertion of anatomical tissue expander, and coverage of the anterior chest wall with Integra artificial skin (Skin, Johnson & Johnson Medical, Division of Ethicon, Inc., Sommerville, NJ). One month later, the outer silicone layer of Integra was substituted by a split-thickness skin autograft and the expander was partly inflated with saline. During the third stage and after overexpansion of the expander had been completed, the expander was removed and a permanent silicone implant was subsequently inserted. No immediate or late complications were observed. At 17 months, the breast contour remains stable, no recontracture has occurred, and the patient evaluates the result as very satisfactory. Expansion of artificial skin Integra appears to be a reliable and safe alternative for reconstruction of the burned breast, lacking the morbidity associated with deep donor sites of full-thickness skin autografts or flaps.
全层前胸壁烧伤会导致挛缩，这可能会限制年轻女性患者乳房的发育。据我们所知，本文首次在文献中介绍了使用双层人工皮肤扩张术治疗烧伤后前胸壁挛缩性瘢痕和单侧乳房发育不全的方法。一名21岁女性在27个月大时遭受热损伤，导致胸壁挛缩，治疗分三个阶段进行。第一阶段包括松解和切除挛缩及瘢痕组织，在肌肉下植入解剖型组织扩张器，并用Integra人工皮肤（强生医疗公司Ethicon分部，新泽西州萨默维尔）覆盖前胸壁。1个月后，将Integra的外层硅胶层替换为自体中厚皮片，并向扩张器内注入部分生理盐水使其膨胀。在第三阶段，待扩张器过度扩张完成后，取出扩张器，随后植入永久性硅胶假体。未观察到即刻或晚期并发症。术后17个月，乳房外形保持稳定，未发生再次挛缩，患者对结果评价非常满意。Integra人工皮肤扩张术似乎是一种可靠且安全的烧伤后乳房重建方法，避免了全厚皮片自体移植或皮瓣供区相关的并发症。
