Manders E K, Oaks T E, Au V K, Wong R K, Furrey J A, Davis T S, Graham W P
Pennsylvania State University, Milton S. Hershey Medical Center, Division of Plastic and Reconstructive Surgery, Hershey, Pa 17033.
Plast Reconstr Surg. 1988 Feb;81(2):208-19. doi: 10.1097/00006534-198802000-00012.
Soft-tissue expansion enjoys ever-wider use, but to date an experience using this technique in the lower extremity has never been presented. We reviewed our first 16 patients to describe the indications and contraindications for the use of tissue expansion in the lower extremity. Guidelines evolved from study of the data. Soft-tissue expansion merits consideration for coverage of problem wounds, in preparation for removal of large benign lesions, and for the repair of contour defects. The operator should know that an open wound below the knee predicts a complication if soft-tissue expansion is attempted in that location. In the thigh, incisions can be confidently placed at the edge of the defect. In every location, large expanders should be chosen so that they are as long as or longer than the adjacent defect. The increase in circumference of the limb should be followed. Simple designs for advancement flaps usually work well. As our experience has grown, reconstruction using soft-tissue expansion in the lower extremity has become safer and the results more predictable through better patient selection and diligent monitoring of intraluminal pressures, even if only by ensuring that the patient is always comfortable. Soft-tissue expansion has a role in reconstruction of the lower extremity.
软组织扩张术的应用越来越广泛，但迄今为止，尚未有人介绍过在下肢使用该技术的经验。我们回顾了首批16例患者，以描述下肢使用组织扩张术的适应证和禁忌证。根据数据研究得出了相关指导原则。软组织扩张术值得考虑用于覆盖问题伤口、为切除大型良性病变做准备以及修复轮廓缺陷。手术医生应该知道，如果在膝部以下尝试进行软组织扩张，开放性伤口预示着会出现并发症。在大腿部位，可以放心地将切口置于缺损边缘。在每个部位，都应选择大尺寸的扩张器，使其长度与相邻缺损相同或更长。应密切关注肢体周长的增加情况。推进皮瓣的简单设计通常效果良好。随着我们经验的积累，通过更好地选择患者并严格监测腔内压力，即使只是确保患者始终舒适，下肢使用软组织扩张术进行重建已变得更加安全，结果也更可预测。软组织扩张术在下肢重建中具有一定作用。
