持续注水快速皮肤软组织扩张术的临床应用
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摘要
目的 探讨一种简单易行的持续快速皮肤软组织扩张方法及其临床应用。
方法 分两期手术：Ⅰ期手术在病变内设计垂直小切口埋植扩张器，术后第二天开始用微量推注泵作持续注水扩张，主要根据病人的痛觉反应和皮肤血运情况调整注水速度，完成预计注水量。注水结束后3～5天行Ⅱ期手术整复治疗，观察手术效果。
结果 临床应用22例，其中瘢痕16例、毛细血管瘤2例、色素痣2例，鼻缺损2例，共埋置扩张器35个，平均注水扩张时间15.3天，扩张过程中1例出现切口处扩张器外露，其余21例扩张过程顺利。Ⅱ期术后出现1例扩张皮瓣远端发生静脉回流障碍致部分坏死，其余21例术后转移皮瓣成活均良好。经3个月～1年的随访，效果满意。
结论 采用病变内垂直小切口埋入扩张器，并早期应用微量推注泵作持续注水扩张可以最大限度地缩短扩张期时间和患者住院时间，简单易行，安全可靠，是一种较理想的快速扩张术式，值得推广应用。
Objective: To study a simple surgical method for continuous rapid tissue expansion and its clinical application.
Methods: The operation can be accomplished in two-stage procedures. First, expanders were placed in the subcutaneous pocket through interlesional perpendicular short incisions. Continuous expansion by trace syringe pump began from the second day after expander placement. The speed of water injection was set by according to patient's algesthesia reaction and vascularity of skin. The second operation was carried out at the third to fifth day after the expansion completed. Results to continuous expansion were assessed.
Result: The method was put into clinical practice on 22 cases (16 cases of scar,
2 cases of capillary angioma, 2 cases of black nevus, 2 cases of nasal defect), and
35 expanders were placed. The mean time of water injection was 15.3 days. In the process of expansion, all cases were satisfactory except 1 case, in which the expander exposed in the incision. After the second operation, all flaps survived except 1 flap showing distal skin necrosis. The result was satisfactory after 3 months to 1 year follow-up visits.
Conclusion: The clinical procedure which consists of expander placement through interlesional perpendicular short incisions and continuous expansion in advance, maximally shortened the time of expansion and hospitalization. This expansion method was a simple, safe, reliable, and ideal rapid tissue expansion. It is worth of wide application.
方法 分两期手术：Ⅰ期手术在病变内设计垂直小切口埋植扩张器，术后第二天开始用微量推注泵作持续注水扩张，主要根据病人的痛觉反应和皮肤血运情况调整注水速度，完成预计注水量。注水结束后3～5天行Ⅱ期手术整复治疗，观察手术效果。
结果 临床应用22例，其中瘢痕16例、毛细血管瘤2例、色素痣2例，鼻缺损2例，共埋置扩张器35个，平均注水扩张时间15.3天，扩张过程中1例出现切口处扩张器外露，其余21例扩张过程顺利。Ⅱ期术后出现1例扩张皮瓣远端发生静脉回流障碍致部分坏死，其余21例术后转移皮瓣成活均良好。经3个月～1年的随访，效果满意。
结论 采用病变内垂直小切口埋入扩张器，并早期应用微量推注泵作持续注水扩张可以最大限度地缩短扩张期时间和患者住院时间，简单易行，安全可靠，是一种较理想的快速扩张术式，值得推广应用。
Objective: To study a simple surgical method for continuous rapid tissue expansion and its clinical application.
Methods: The operation can be accomplished in two-stage procedures. First, expanders were placed in the subcutaneous pocket through interlesional perpendicular short incisions. Continuous expansion by trace syringe pump began from the second day after expander placement. The speed of water injection was set by according to patient's algesthesia reaction and vascularity of skin. The second operation was carried out at the third to fifth day after the expansion completed. Results to continuous expansion were assessed.
Result: The method was put into clinical practice on 22 cases (16 cases of scar,
2 cases of capillary angioma, 2 cases of black nevus, 2 cases of nasal defect), and
35 expanders were placed. The mean time of water injection was 15.3 days. In the process of expansion, all cases were satisfactory except 1 case, in which the expander exposed in the incision. After the second operation, all flaps survived except 1 flap showing distal skin necrosis. The result was satisfactory after 3 months to 1 year follow-up visits.
Conclusion: The clinical procedure which consists of expander placement through interlesional perpendicular short incisions and continuous expansion in advance, maximally shortened the time of expansion and hospitalization. This expansion method was a simple, safe, reliable, and ideal rapid tissue expansion. It is worth of wide application.
引文
1. Radovan C. Breast reconstruction after mastectomy using the temporary expander. Plast Reconstr Surg, 1982, 69: 199-206.
2．鲁开化，艾玉峰主编．皮肤软组织扩张术．金盾出版社，1991，1-3．
3. Marks MW, Mackenzie JR, Burney RE, et al. Response of random skin flaps to rapid expansion. J Trauma, 1985, 25(10): 947-952.
4. Schmidt SC, Logan SE, Hayden JM, et al. Continuous versus conventional tissue expansion: experimental verification of a new technique. Plast Reconstr Surg, 1991, 87: 10-15.
5. Cole RP, Gault DT, Mayon BJ, et al. Pain and forehead expansion. Br J Plast surg, 1991, 41: 41-43.
6. Sasaki GH. Intraoperative sustained limited expansion (ISLE) as an immediate reconstructive technique. Clin Plast Surg, 1987, 14: 563-573.
7. Pietila JP, Nordstrom RE, Virkkunen PJ, et al. Accelerated tissue expansion with the "overfilling" technique. Plast Reconstr Surg, 1988, 81: 204-207.
8. Mustoe TA, Bartell TH, Garner WL. Physical, biomechanical, histologic, and biochemical effect of rapid versus conventional tissue expansion. Plast Reconstr Surg, 1989, 83: 687-691.
9．范志宏，张涤生，关文祥，等。皮肤软组织快速扩张的实验研究。中华整形烧伤外科杂志，1995，11：375-378．
10．李江，鲁开化，艾玉峰，等．扩张后皮肤软组织收缩机理的实验研究．中华整形外科杂志，2002，18：173-174．
11．李江，鲁开化，肖建华，等．持续扩张后任意皮瓣的活力及回缩的动态观察．中华整形外科杂志，2000，16：24-26．
12. Nunes PH, Vargas VE, Guidi MC, et al. Continuous expansion for the treatment of skin deformities. Aesthetic Plast Surg, 1996, 20: 347-349.
13．．胡华新，孙广慈，赫伟，等．持续无痛快速扩张法及其临床应用．中华整形烧伤外科杂志，1995，1：167-170．
14．鲁开化，艾玉峰，郭树忠，等．皮肤扩张术在整形外科应用的经验．中华整形
烧伤外科杂志，1996，12：60-61．
15．刘学军，孙广慈，王月华．维持扩张期对扩张皮肤张力和即时回缩率影响的研究．中华整形烧伤外科杂志，2002，18：302-304．
2．鲁开化，艾玉峰主编．皮肤软组织扩张术．金盾出版社，1991，1-3．
3. Marks MW, Mackenzie JR, Burney RE, et al. Response of random skin flaps to rapid expansion. J Trauma, 1985, 25(10): 947-952.
4. Schmidt SC, Logan SE, Hayden JM, et al. Continuous versus conventional tissue expansion: experimental verification of a new technique. Plast Reconstr Surg, 1991, 87: 10-15.
5. Cole RP, Gault DT, Mayon BJ, et al. Pain and forehead expansion. Br J Plast surg, 1991, 41: 41-43.
6. Sasaki GH. Intraoperative sustained limited expansion (ISLE) as an immediate reconstructive technique. Clin Plast Surg, 1987, 14: 563-573.
7. Pietila JP, Nordstrom RE, Virkkunen PJ, et al. Accelerated tissue expansion with the "overfilling" technique. Plast Reconstr Surg, 1988, 81: 204-207.
8. Mustoe TA, Bartell TH, Garner WL. Physical, biomechanical, histologic, and biochemical effect of rapid versus conventional tissue expansion. Plast Reconstr Surg, 1989, 83: 687-691.
9．范志宏，张涤生，关文祥，等。皮肤软组织快速扩张的实验研究。中华整形烧伤外科杂志，1995，11：375-378．
10．李江，鲁开化，艾玉峰，等．扩张后皮肤软组织收缩机理的实验研究．中华整形外科杂志，2002，18：173-174．
11．李江，鲁开化，肖建华，等．持续扩张后任意皮瓣的活力及回缩的动态观察．中华整形外科杂志，2000，16：24-26．
12. Nunes PH, Vargas VE, Guidi MC, et al. Continuous expansion for the treatment of skin deformities. Aesthetic Plast Surg, 1996, 20: 347-349.
13．．胡华新，孙广慈，赫伟，等．持续无痛快速扩张法及其临床应用．中华整形烧伤外科杂志，1995，1：167-170．
14．鲁开化，艾玉峰，郭树忠，等．皮肤扩张术在整形外科应用的经验．中华整形
烧伤外科杂志，1996，12：60-61．
15．刘学军，孙广慈，王月华．维持扩张期对扩张皮肤张力和即时回缩率影响的研究．中华整形烧伤外科杂志，2002，18：302-304．