摘要
目的探讨用髂腹股沟皮瓣整复大面积深度烧伤后会阴部闭锁畸形的效果。方法2010年1月-2015年6月，笔者单位收治5例大面积深度烧伤后会阴部闭锁畸形患者，烧伤总面积为35％～55％TBSA，Ⅲ～Ⅳ度，瘢痕病程6个月～3年。患者瘢痕累及双侧腹股沟、大腿内侧、阴阜、骶尾部及会阴中心区，双下肢外展成角30～65°，肛门口狭窄，排便困难。会阴部瘢痕松解后，创面大小为23cm×12cm～28cm×24cm。3例患者切取单侧髂腹股沟皮瓣整复；2例患者的会阴部创面巨大，其中1例切取双侧髂腹股沟皮瓣整复，1例切取单侧髂腹股沟皮瓣与股前外侧皮瓣联合整复。单侧髂腹股沟皮瓣面积为23cm×12cm～30cm×20cm、股前外侧皮瓣面积为21cm×12cm，在整复创面的同时行肛门口外形重建。腹部供瓣区部分缝合、部分游离移植自体头部刃厚皮或背部薄中厚皮，大腿供瓣区直接拉拢缝合。术后用石膏固定双下肢于外展位，严格制动。结果术后皮瓣全部成活，创面愈合良好。随访6～12个月，皮瓣外形良好、质地柔软、无挛缩，髋关节活动良好，双下肢外展成角110～135°，肛周外形良好、皮肤无炎症、排便正常，患者或家属对供瓣区外形表示可以接受。结论髂腹股沟皮瓣是整复烧伤后会阴部闭锁畸形的一种较好选择。
Objective To explore the effect of ilioinguinal flap on reconstruction of perineal obliteration deformity after extensive deep burn. Methods Five patients with perineal obliteration deformity after extensive deep burn were hospitalized from January 2010 to June 2015, with total burn area ranging from 35% to 55% total body surface area, depth of full-thickness burn and wound deep to bone, and course of scar from 6 months to 3 years. Scars of patients were involved in bilateral groins, inner thighs, monsveneris, sacrococcygeal region, and central area of perineum. The abduction angles of double lower limbs ranged from 30 to 65°. Anus was narrow, and defecation was difficult. After release of scar tissue in perineal region, the wound area ranged from 23 cm x 12 cm to 28 cm x 24 cm. For wound repair and reconstruction of anus, unilateral ilioinguinal flap was used in 3 cases. Due to large wound in two patients, bilateral ilioinguinal flap was used in one patient, and unilateral ilioinguinal flap combined with anterolateral femoral flap was used in another one patient. The area of unilateral ilioinguinal flap ranged from 23 cm× 12 cm to 30 cm ×20 cm, and the area of anterolateral femoral flap was 21 cm× 12 cm. The abdominal donor site was closed with partial suture and partial skin grafting （ harvested from split-thickness skin of autologous head or thin intermediate-thickness skin of autologous back）. The femoral donor site was directly sutured. After the operation, the double lower limbs were fixed with plaster on abducent position and strictly immobilized. Results All the flaps survived after operation and the wounds healed well. During the follow-up for 6 to 12 months, the appearance of flaps were good with soft texture and no contracture. Hip joint motion was good, and abduction angles of double lower limbs ranged from 110 to 135°. The appearance of crissum was good without skin inflammation and with normal function of defecation. The appearance of donor site was acceptable to patients or their parents.
出处
《中华烧伤杂志》
CAS
CSCD
北大核心
2016年第12期709-713,共5页
Chinese Journal of Burns
关键词
外科皮瓣
会阴
瘢痕
挛缩
髂腹股沟
Surgical flaps
Perineum
Cicatrix
Contracture
Iliogroin
