Yuan B, Liang H D, Tong Z H, Song W J, Ju S L
Department of Reparative and Reconstructive Surgery, the Second Hospital of Dalian Medical University, Dalian 116023, China.
Department of Hands and Feet Microsurgery, the Second Hospital of Dalian Medical University, Dalian 116023, China.
Zhonghua Shao Shang Za Zhi. 2020 Dec 20;36(12):1204-1207. doi: 10.3760/cma.j.cn501120-20200215-00061.
To explore the application effect of sustainable skin-stretching device in scalp and soft tissue defect. From June 2017 to January 2020, 5 patients (3 males and 2 females, aged 31-57 (38.0±2.1) years) with large area of scalp and soft tissue defect and skull exposure were admitted to Department of Reparative and Reconstructive Surgery of the Second Hospital of Dalian Medical University. The wound area ranged from 16.0 cm×8.0 cm to 18.0 cm×12.0 cm. The sustainable skin-stretching device was installed after debridement operation for scalp wound. The wound was stretched from the 3rd day after installation of the device, at a basic speed of 1 mm/d and finished for 3 times on average. During stretching, close attention was paid to the changes in blood flow of the wound margin and the subjective feeling of the patients. When the result was negative in the squeezing and pinching test for wound margin after stretching, the further stretching was stopped, the final stretching state was maintained for 3 days, and the wounds were sutured directly. The wound healing during stretching of sustainable skin-stretching device and the occurrence of complications were observed. The rest wound areas after stretching for 5, 10, 15, and 20 days were measured. The wound healing and hair growth were observed during follow-up. All the wounds of 5 patients was sutured directly after stretching for 19-23 d. There was no tension blister on the margin of wounds during stretching, and the margin of wounds healed well after being sutured without skin necrosis. After stretching treatment for 5-20 d, the wound areas were gradually decreased. During follow-up of 2-11 (4.5±1.5) months, the elasticity, color, feeling, and regenerated hair growth of the stretched scalp tissue were close to those of the surrounding normal skin tissue. The linear scar formed on the margin of wounds, but no scar formed on the wounds. The application of sustainable skin-stretching device can reduce the difficulty in repairing scalp and soft tissue defect, with the regenerated hair growing well after treatment, which is worthy of clinical promotion.
探讨可持续皮肤拉伸装置在头皮及软组织缺损中的应用效果。2017年6月至2020年1月，大连医科大学附属第二医院修复重建外科收治5例头皮及软组织大面积缺损并颅骨外露患者（男3例，女2例，年龄31 - 57（38.0±2.1）岁）。创面面积为16.0 cm×8.0 cm至18.0 cm×12.0 cm。头皮创面清创术后安装可持续皮肤拉伸装置。装置安装后第3天开始拉伸创面，基本速度为1 mm/d，平均完成3次。拉伸过程中，密切关注创缘血流变化及患者主观感受。拉伸后创缘挤压试验结果为阴性时，停止进一步拉伸，维持最终拉伸状态3天，然后直接缝合创面。观察可持续皮肤拉伸装置拉伸过程中创面愈合情况及并发症发生情况。测量拉伸5、10、15和20天后剩余创面面积。随访期间观察创面愈合及毛发生长情况。5例患者创面均在拉伸19 - 23天后直接缝合。拉伸过程中创缘无张力性水疱，缝合后创缘愈合良好，无皮肤坏死。拉伸治疗5 - 20天后，创面面积逐渐减小。随访2 - 11（4.5±1.5）个月，拉伸后头皮组织的弹性、颜色、感觉及再生毛发生长情况接近周围正常皮肤组织。创面边缘形成线性瘢痕，但创面无瘢痕形成。可持续皮肤拉伸装置的应用可降低头皮及软组织缺损修复难度，治疗后再生毛发生长良好，值得临床推广。
