摘要
目的探讨颈部烧伤瘢痕挛缩的手术治疗方法及效果。方法本组121例烧伤后颈部瘢痕挛缩患者(无1例为新鲜烧伤),根据病情程度分别采用"Z"成形术、厚皮片移植术、"Z"成形加厚皮片移植术、邻位皮瓣移植术和邻位皮瓣加皮片移植术进行手术整复。对于烧伤后颌颈瘢痕严重挛缩的患者,采用仅对挛缩瘢痕切开松解而不切除的手术方法,灵活设计切口,利用挛缩部位已成熟的瘢痕形成较大面积三角形瘢痕瓣来修复创面;切口解剖深度直达舌骨甲状软骨沟平面并彻底松解挛缩组织,以塑造明显的颌颈角。结果本组121例患者的瘢痕挛缩得到最大程度的松解,均获得满意或较为满意的近期疗效。患者颈部活动自如,外观改善显著,颌颈角明显。结论对于供皮区缺乏的严重颈部瘢痕挛缩的患者,利用特殊切口及设计面积较大的瘢痕瓣修复部分创面,同样可获得满意疗效;切口解剖至舌骨甲状软骨沟深度,并彻底松解所有挛缩的软组织,可显现较为美观的颌颈角。
Objective To investigate the surgical procedure and efficacy of cervical scar contracture after cervical burns. Methods One hundred and twenty one cases of cervical scar contracture after cervical burns were included in the study, and none was fresh burn. According to disease severity, all the patients were treated by one of the following five methods： Z-plasty, thick free skin graft, Z-plasty plus thick free skin graft, adjacent skin flap graft and adjacent skin flap plus free skin graft. However, for those with severe mandibulocervical scar contracture after burn, within the comprehensive treatment aforementioned, a special incision on the matured scar was designed, which formed two triangular scar flaps at the two ends of the incision to cover the residual wound. The incision was carried deep down to the superficial surface of the cervical muscles. All the contracted normal tissues beneath the scar, usually the contracted tissue bands, were divided to achieve a thorough release of the contracture. Dissection was then carried deep down to expose the groove between the hyoid and thyroid cartilages. In this way, a permanent and prominent mandibulocervical angle was expected postoperatively. Results All 121 cases obtained satisfactory results. The scar contracture was fully released, a prominent mandibulocervical angle was formed and a free neck movement in all directions was achieved. Conclusion In severe cervical scar contracture, due to deficient donor site, it is possible to design an incision having two triangular scar flaps on its both ends, which cover part of the wound instead of skin graft, and a same good result can be expected. To create a prominent mandibulocervical angle, one must dissect the tissues deep down to the groove between the hyoid and mandibular cartilages.
出处
《上海交通大学学报（医学版）》
CAS
CSCD
北大核心
2007年第11期1376-1378,共3页
Journal of Shanghai Jiao tong University:Medical Science
关键词
瘢痕挛缩
“Z”成形术
瘢痕瓣
颌颈角
scar contracture
Z-plasty
scar flap
cervico-mandibular angle
