Ramakrishnan K M, Jayaraman V, Ramachandran K, Mathivanan T
Department of Burns, Plastic and Reconstructive Surgery, Kilpauk Medical College, Madras, India.
Plast Reconstr Surg. 1988 Aug;82(2):262-6. doi: 10.1097/00006534-198808000-00009.
Acute and chronic burns leave behind a full-thickness defect that always requires a flap cover. Such defects are common in electrical burn injuries of the limbs. This paper deals with 35 patients with full-thickness defects following burns in whom deepithelialized turnover dermis flaps and deepithelialized turnover flaps with deep fascia have been used. This flap is an extension of Hynes's reversed dermis graft and Smahel's deepithelialized turnover flap where there is a larger area of blood supply on the deeper aspect of the dermis. If a good hinge is provided for safe blood supply, such a flap settles well in the defect, and cumbersome multistaged procedures can be avoided. If there is less fatty tissue in the area of flap used, then reversed dermis flaps are ideal because split-skin graft take is good. When there is a lot of fatty tissue on the undersurface of dermis, the fascia is also included to make it a reversed fasciocutaneous flap to augment the blood supply and for better split-skin graft survival. Advantages of the procedure and complications are elaborated.
急性和慢性烧伤会留下全层缺损，这种缺损始终需要皮瓣覆盖。此类缺损在四肢电烧伤中很常见。本文探讨了35例烧伤后出现全层缺损的患者，这些患者采用了去上皮化翻转真皮瓣和带深筋膜的去上皮化翻转瓣。这种皮瓣是海因斯（Hynes）反向真皮移植术和斯马赫尔（Smahel）去上皮化翻转瓣的延伸，在真皮深层有更大的血供面积。如果为安全血供提供一个良好的蒂，这样的皮瓣能很好地贴合缺损部位，并且可以避免繁琐的多阶段手术。如果所用皮瓣区域的脂肪组织较少，那么反向真皮瓣是理想选择，因为刃厚皮片移植成活率高。当真皮下面有大量脂肪组织时，也会包含筋膜，使其成为反向筋膜皮瓣，以增加血供并提高刃厚皮片的成活率。文中阐述了该手术的优点和并发症。
