全厚皮片移植修复患儿手部瘢痕挛缩畸形的效果及预后分析
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摘要
目的:探究全厚皮片移植手术在治疗小儿手部瘢痕挛缩畸形上的康复效果及预后恢复情况。方法:选择2016年3月-2018年1月在笔者医院进行手术治疗的37例手部瘢痕挛缩畸形患儿作为研究对象,所有患儿均采用全厚皮片移植进行修复治疗,观察其修复治疗效果、康复效果及预后恢复情况。结果:37例患儿经全厚皮片移植手术治疗后修复效果良好,皮瓣成活率为100.00%,未见有皮下感染、血肿、皮肤坏死等不良反应发生,手部受累关节部位均得到有效纠正。治疗后3个月,患儿VSS量表评分明显低于治疗前,瘢痕评估结果明显优于治疗前,手部关节活动优良率(75.68%)显著高于治疗前(32.43%),差异有统计学意义(P<0.05)。治疗后6个月,患儿的手部功能及外观整形恢复优良率为86.49%,明显高于治疗后3个月(48.65%),差异有统计学意义(P<0.05)。结论:全厚皮片移植手术修复小儿手部瘢痕挛缩畸形效果良好,能够有效改善患儿手部瘢痕挛缩畸形和色素沉着,使其手部关节功能和外形美观程度得到显著提升,值得在临床中推广应用。
Objective To research the effect and prognosis of full-thickness skin grafting for children with hand scar contracture deformity. Methods From March 2016 to January 2018, 37 cases of children with hand deformity contracture deformity in our hospital were selected as the research subjects. All children were treated with full-thickness skin grafting, and the effects of repair, and the rehabilitation and prognosis were observed. Results 37 cases were repaired with full-thickness skin graft, and the survival rate was 100.00%. There were no adverse reaction such as subcutaneous infection, hematoma, skin necrosis and so on. 3 months after treatment, the score of VSS was significantly lower than that before treatment, and the result of scar assessment was significantly better than that before treatment, the excellent and good rate of hand joint movement(75.68%) was significantly higher than that before treatment(32.43%), the differences were statistically significant(P<0.05). 6 months after treatment, the excellent and good recovery rate of hand function and appearance was 86.49%, which was significantly higher than that of 3 months after treatment(48.65%), the difference was statistically significant(P<0.05). Conclusion Full-thickness skin graft has good effect on the repair of children's hand scar contracture deformity. It can effectively improve the children's hand scars, contracture deformity and pigmentation, so that the function and appearance of the hand are improved significantly.
Objective To research the effect and prognosis of full-thickness skin grafting for children with hand scar contracture deformity. Methods From March 2016 to January 2018, 37 cases of children with hand deformity contracture deformity in our hospital were selected as the research subjects. All children were treated with full-thickness skin grafting, and the effects of repair, and the rehabilitation and prognosis were observed. Results 37 cases were repaired with full-thickness skin graft, and the survival rate was 100.00%. There were no adverse reaction such as subcutaneous infection, hematoma, skin necrosis and so on. 3 months after treatment, the score of VSS was significantly lower than that before treatment, and the result of scar assessment was significantly better than that before treatment, the excellent and good rate of hand joint movement(75.68%) was significantly higher than that before treatment(32.43%), the differences were statistically significant(P<0.05). 6 months after treatment, the excellent and good recovery rate of hand function and appearance was 86.49%, which was significantly higher than that of 3 months after treatment(48.65%), the difference was statistically significant(P<0.05). Conclusion Full-thickness skin graft has good effect on the repair of children's hand scar contracture deformity. It can effectively improve the children's hand scars, contracture deformity and pigmentation, so that the function and appearance of the hand are improved significantly.
引文
[1]王光华,卫伟.手瘢痕挛缩畸形整形疗效分析[J].中国美容医学,2017,26(2):26-28.
[2]黄竞卓,王韶亮,刘婷,等.手部烧伤后瘢痕挛缩的治疗体会[J].局解手术学杂志,2017,26(4):294-296.
[3]Byrne M,O'Donnell M,Fitzgerald L,et al.Early experience with fat grafting as an adjunct for secondary burn reconstruction in the hand:technique,hand function assessment and aesthetic outcomes[J].Burns,2016,42(2):356-365.
[4]丁菲菲,林源,蒙诚跃,等.手指瘢痕挛缩屈曲严重畸形的矫形治疗[J].中华损伤与修复杂志(电子版),2015,10(1):30-32.
[5]张会堂,杨崇志,柴玉兰.早期功能部位整形手术对深Ⅱ度烧伤创面愈合后瘢痕挛缩畸形和关节功能障碍的影响[J].创伤外科杂志,2015,17(5):452-454.
[6]高雅姗,昝涛,李海洲,等.预扩张皮瓣及植皮治疗面颈部及关节部瘢痕挛缩的比较研究[J].中国修复重建外科杂志,2015,29(9):1124-1128.
[7]庞梦茹,肖海涛,王怀胜,等.应用不同皮瓣修复手掌重度瘢痕挛缩畸形的临床分析[J].中国修复重建外科杂志,2016,30(3):382-384.
[8]王光华,卫伟.手瘢痕挛缩畸形整形疗效分析[J].中国美容医学,2017,26(2):26-28.
[9]路训平.手指瘢痕挛缩屈曲严重畸形的矫形治疗研究[J].中国矫形外科杂志,2016,24(16):1521-1523.
[10]Garcia LP,Huang A,Corlew DS,et al.Factors affecting burn contracture outcome in developing countries:a review of 2 506 patients[J].Ann Plast Surg,2016,77(3):290-296.
[11]刘晓虹,孙亚楠,王瑜慧,等.婴幼儿手烧伤后瘢痕畸形早期整形手术经验总结[J].中华损伤与修复杂志(电子版),2015,10(1):20-23.
[12]谷明娟.手部烧伤患者瘢痕挛缩畸形的整复方法及临床效果分析[J].中国医疗美容,2016,6(3):44-45.
[13]李云峰,吴泽勇,黄海华,等.全厚皮片游离移植矫治儿童足背瘢痕挛缩畸形[J].中国美容医学,2018,27(3):27-29.
[14]任静,韩岩,王白石,等.全厚植皮与扩张胸三角皮瓣转移修复面部大面积皮肤缺损[J].中国美容整形外科杂志,2017,28(10):596-598.
[15]郝永红,许明火,高全文,等.全厚皮片移植修复手部瘢痕挛缩畸形[J].中国美容医学,2015,24(8):14-15.
[16]李允.全厚皮片移植及大张厚中厚皮移植对烧伤后手外形功能恢复的疗效分析[J].中国实用医药,2016,11(19):73-74.
[17]徐成,王峰,范锟铻,等.人工真皮联合自体刃厚皮片移植在烧伤瘢痕整复中的应用[J].江西医药,2015,50(7):676-677.
[18]Prasetyono TO,Koswara AF.Retrospective analysis of the oneper-million tumescent technique in post-burn hand deformity surgeries[J].Arch Plast Surg,2015,42(2):164-172.
[2]黄竞卓,王韶亮,刘婷,等.手部烧伤后瘢痕挛缩的治疗体会[J].局解手术学杂志,2017,26(4):294-296.
[3]Byrne M,O'Donnell M,Fitzgerald L,et al.Early experience with fat grafting as an adjunct for secondary burn reconstruction in the hand:technique,hand function assessment and aesthetic outcomes[J].Burns,2016,42(2):356-365.
[4]丁菲菲,林源,蒙诚跃,等.手指瘢痕挛缩屈曲严重畸形的矫形治疗[J].中华损伤与修复杂志(电子版),2015,10(1):30-32.
[5]张会堂,杨崇志,柴玉兰.早期功能部位整形手术对深Ⅱ度烧伤创面愈合后瘢痕挛缩畸形和关节功能障碍的影响[J].创伤外科杂志,2015,17(5):452-454.
[6]高雅姗,昝涛,李海洲,等.预扩张皮瓣及植皮治疗面颈部及关节部瘢痕挛缩的比较研究[J].中国修复重建外科杂志,2015,29(9):1124-1128.
[7]庞梦茹,肖海涛,王怀胜,等.应用不同皮瓣修复手掌重度瘢痕挛缩畸形的临床分析[J].中国修复重建外科杂志,2016,30(3):382-384.
[8]王光华,卫伟.手瘢痕挛缩畸形整形疗效分析[J].中国美容医学,2017,26(2):26-28.
[9]路训平.手指瘢痕挛缩屈曲严重畸形的矫形治疗研究[J].中国矫形外科杂志,2016,24(16):1521-1523.
[10]Garcia LP,Huang A,Corlew DS,et al.Factors affecting burn contracture outcome in developing countries:a review of 2 506 patients[J].Ann Plast Surg,2016,77(3):290-296.
[11]刘晓虹,孙亚楠,王瑜慧,等.婴幼儿手烧伤后瘢痕畸形早期整形手术经验总结[J].中华损伤与修复杂志(电子版),2015,10(1):20-23.
[12]谷明娟.手部烧伤患者瘢痕挛缩畸形的整复方法及临床效果分析[J].中国医疗美容,2016,6(3):44-45.
[13]李云峰,吴泽勇,黄海华,等.全厚皮片游离移植矫治儿童足背瘢痕挛缩畸形[J].中国美容医学,2018,27(3):27-29.
[14]任静,韩岩,王白石,等.全厚植皮与扩张胸三角皮瓣转移修复面部大面积皮肤缺损[J].中国美容整形外科杂志,2017,28(10):596-598.
[15]郝永红,许明火,高全文,等.全厚皮片移植修复手部瘢痕挛缩畸形[J].中国美容医学,2015,24(8):14-15.
[16]李允.全厚皮片移植及大张厚中厚皮移植对烧伤后手外形功能恢复的疗效分析[J].中国实用医药,2016,11(19):73-74.
[17]徐成,王峰,范锟铻,等.人工真皮联合自体刃厚皮片移植在烧伤瘢痕整复中的应用[J].江西医药,2015,50(7):676-677.
[18]Prasetyono TO,Koswara AF.Retrospective analysis of the oneper-million tumescent technique in post-burn hand deformity surgeries[J].Arch Plast Surg,2015,42(2):164-172.