Song Yijun, Li Yatong, Xia Chuan, Zhang Mingzi, Yu Nanze, Huang Jiuzuo, Long Xiao, Wang Xiaojun
Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China.
J Burn Care Res. 2019 Oct 16;40(6):966-971. doi: 10.1093/jbcr/irz134.
Z-plasty is widely employed in plastic surgery and its mainly functions include elongation along the axis of the scar, dispersal, and realigning the scar within the lines of minimal tension. It is especially useful to release linear-scar contracture, yet difficult for wide scars. Here, we described a technique of tissue expansion followed by serial Z-plasty for several cases of severe postburn scar contracture. In this procedure, first, full expansion should be achieved in the tissues adjacent to the contracture by tissue expansion. Then, the serial Z-plasty technique with precise trimming and adjustment is performed with adequate tension-free skin to release the contracture. Over a period of 2 years from 2015 to 2017, this technique was employed in moderate or severe postburn scar contracture in four patients (1 male and 3 females) aged 14 to 40 years old. The size of contracture ranged from 5 to 27 cm in diameter. Improved appearance and excellent skin match was observed in our four patients. All patients healed uneventfully without any complications and no patient required revision surgery. The range of motion, short form-36 health survey and Vancouver Scar Scale indicated that this technique offered a durable skin coverage with satisfying appearance in these patients. Through the outcomes of our patients, tissue expansion followed by serial Z-plasty has a great potential to be a useful alternative for the treatment of scar contracture especially for contracture adjacent to cervical joints.
Z成形术在整形外科中广泛应用，其主要功能包括沿瘢痕轴延长、分散并使瘢痕在张力最小的线上重新排列。它对于松解线性瘢痕挛缩特别有用，但对于较宽的瘢痕则较困难。在此，我们描述了一种组织扩张后行系列Z成形术治疗几例严重烧伤后瘢痕挛缩的技术。在该手术中，首先，通过组织扩张在挛缩邻近的组织中实现充分扩张。然后，用无张力的足够皮肤进行精确修剪和调整的系列Z成形术以松解挛缩。在2015年至2017年的2年期间，该技术应用于4例年龄在14至40岁的中重度烧伤后瘢痕挛缩患者（1例男性和3例女性）。挛缩大小直径范围为5至27厘米。我们的4例患者外观均有改善且皮肤匹配良好。所有患者均顺利愈合，无任何并发症，且无需进行修复手术。活动范围、简短健康调查问卷36项和温哥华瘢痕量表表明，该技术为这些患者提供了持久的皮肤覆盖且外观令人满意。通过我们患者的治疗结果，组织扩张后行系列Z成形术极有可能成为治疗瘢痕挛缩尤其是颈部关节附近挛缩的一种有效替代方法。
