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[髂腹股沟皮瓣修复广泛深度烧伤后会阴闭锁畸形]

[Reconstruction of perineal obliteration deformity after extensive deep burn with ilioinguinal flap].

作者信息

Shen Y M, Ma C X, Qin F J, Wang C, Du W L, Zhang C

机构信息

Department of Burns, Beijing Jishuitan Hospital, Beijing 100035, China.

出版信息

Zhonghua Shao Shang Za Zhi. 2016 Dec 20;32(12):709-713. doi: 10.3760/cma.j.issn.1009-2587.2016.12.002.

Abstract

To explore the effect of ilioinguinal flap on reconstruction of perineal obliteration deformity after extensive deep burn. Five patients with perineal obliteration deformity after extensive deep burn were hospitalized from January 2010 to June 2015, with total burn area ranging from 35% to 55% total body surface area, depth of full-thickness burn and wound deep to bone, and course of scar from 6 months to 3 years. Scars of patients were involved in bilateral groins, inner thighs, monsveneris, sacrococcygeal region, and central area of perineum. The abduction angles of double lower limbs ranged from 30 to 65°. Anus was narrow, and defecation was difficult. After release of scar tissue in perineal region, the wound area ranged from 23 cm×12 cm to 28 cm×24 cm. For wound repair and reconstruction of anus, unilateral ilioinguinal flap was used in 3 cases. Due to large wound in two patients, bilateral ilioinguinal flap was used in one patient, and unilateral ilioinguinal flap combined with anterolateral femoral flap was used in another one patient. The area of unilateral ilioinguinal flap ranged from 23 cm×12 cm to 30 cm×20 cm, and the area of anterolateral femoral flap was 21 cm×12 cm. The abdominal donor site was closed with partial suture and partial skin grafting (harvested from split-thickness skin of autologous head or thin intermediate-thickness skin of autologous back). The femoral donor site was directly sutured. After the operation, the double lower limbs were fixed with plaster on abducent position and strictly immobilized. All the flaps survived after operation and the wounds healed well. During the follow-up for 6 to 12 months, the appearance of flaps were good with soft texture and no contracture. Hip joint motion was good, and abduction angles of double lower limbs ranged from 110 to 135°. The appearance of crissum was good without skin inflammation and with normal function of defecation. The appearance of donor site was acceptable to patients or their parents. Ilioinguinal flap is a good choice for reconstruction of perineal obliteration deformity after burn.

摘要

探讨髂腹股沟皮瓣修复大面积深度烧伤后会阴闭锁畸形的效果。2010年1月至2015年6月收治5例大面积深度烧伤后会阴闭锁畸形患者,烧伤总面积35%~55%,均为Ⅲ度烧伤且创面深达骨质,瘢痕病程6个月至3年。患者瘢痕累及双侧腹股沟、大腿内侧、阴阜、骶尾部及会阴中心区,双下肢外展角度30°~65°,肛门狭窄,排便困难。会阴区瘢痕组织松解后创面面积为23 cm×12 cm至28 cm×24 cm。3例采用单侧髂腹股沟皮瓣修复创面并重建肛门,1例因创面较大采用双侧髂腹股沟皮瓣,1例采用单侧髂腹股沟皮瓣联合股前外侧皮瓣。单侧髂腹股沟皮瓣面积为23 cm×12 cm至30 cm×20 cm,股前外侧皮瓣面积为21 cm×12 cm。腹部供区采用部分缝合、部分植皮(取自自体头部刃厚皮或背部薄中厚皮)封闭,股部供区直接缝合。术后双下肢用石膏固定于外展位并严格制动。术后皮瓣全部成活,创面愈合良好。随访6~12个月,皮瓣外观良好,质地柔软,无挛缩,髋关节活动良好,双下肢外展角度110°~135°,会阴外观良好,无皮肤炎症,排便功能正常,供区外观患者及家属满意。髂腹股沟皮瓣是修复烧伤后会阴闭锁畸形的较好选择。

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