多个扩张器临床应用的经验总结
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摘要
我院整形外科于2006年3月至2009年3月间收治了15例利用两个及以上扩张器来修复切除巨痣和较大面积瘢痕后形成的皮肤缺损的患者,通过对该组患者治疗过程和修复结果的深入研究,总结多个扩张器植入术的切口设计和并发症预防方面的经验。该组患者所修复的皮肤缺损面积最小为4.5cm×2.0cm,最大面积达19cm×21cm。所有病例均采用两个或以上扩张器进行手术治疗,术前认真设计手术方案,术中规范操作,冷光源直视下彻底止血,术后精心护理,注液扩张有序进行。结果除1例患者因扩张器外露严重导致部分瘢痕未能被修复外,所有患者拟修复的皮肤缺损区域均得到有效修复,随访1~12个月,所有患者修复区皮肤色泽、质地及功能良好,供区损伤小,修复效果较为满意。通过该研究我们可得出下述结论:相邻的扩张器埋植尽量选用同一切口,既减少了创伤又为二期皮瓣转移留有更大的余地;垂直于扩张囊的切口在扩张后期更不易裂开。应用冷光源直视下止血是预防血肿的重要措施;采用“栅栏”缝合、相邻扩张器注水速度协调一致能有效预防扩张器外露。
Objective:
The purpose of this study is to research the incision design and the complication prevention of the multi-expanders implantation.
Methods:
Fifteen patients (7 males and 8 females) with ages ranging from 5 to 51, consecutively, with large defects of the skin between March of 2006 and March of 2009 are included in this study. The reasons resulted to the large defects of the skin of these patients are as follows:①t he resection of the giant nevus②the treating of large scar.We treated them by skin soft-tissue expansion with two or more expanders. The minimum area of the skin defect was 4.5cm×2.0cm,and the largest area of the skin defect was 19cm×21cm.
Preoperative photographs should be taken.Before the operation, the position of the expanders and the incision lines were marked out with methylene blue. Cavities of suitable size were formed mainly by dissecting the skin-soft tissue. Make sure any living bleeding was stopped by using the gauze or electric coagulation. Insert the negative pressure drainage before inserting the expanders. Close the incision finally.
The second step was injecting the normal saline time by time into the expander to make the skin-soft tissue expanded.This phase might last for several months until enough skin was produced.
The last important procedure was to take out the expanders and repair the skin defects according to skin flaps transfering.
Results:
All the patients who received the skin soft-tissue expansion with two or more expanders had perfect results except one patient. Most patients were satisfied with the flap’s color and luster,and also the regional function. The rates of the complication happening were not very high,but still higher than it in the single expander skin soft-tissue expansion.
Conclusions:
1. We can use one incision for the adjacent expanders; the incision which is perpendicular with the expanders is better.
2. To stop bleeding by using the cold light source and to use grating suture can prevent complication effectively.
Objective:
The purpose of this study is to research the incision design and the complication prevention of the multi-expanders implantation.
Methods:
Fifteen patients (7 males and 8 females) with ages ranging from 5 to 51, consecutively, with large defects of the skin between March of 2006 and March of 2009 are included in this study. The reasons resulted to the large defects of the skin of these patients are as follows:①t he resection of the giant nevus②the treating of large scar.We treated them by skin soft-tissue expansion with two or more expanders. The minimum area of the skin defect was 4.5cm×2.0cm,and the largest area of the skin defect was 19cm×21cm.
Preoperative photographs should be taken.Before the operation, the position of the expanders and the incision lines were marked out with methylene blue. Cavities of suitable size were formed mainly by dissecting the skin-soft tissue. Make sure any living bleeding was stopped by using the gauze or electric coagulation. Insert the negative pressure drainage before inserting the expanders. Close the incision finally.
The second step was injecting the normal saline time by time into the expander to make the skin-soft tissue expanded.This phase might last for several months until enough skin was produced.
The last important procedure was to take out the expanders and repair the skin defects according to skin flaps transfering.
Results:
All the patients who received the skin soft-tissue expansion with two or more expanders had perfect results except one patient. Most patients were satisfied with the flap’s color and luster,and also the regional function. The rates of the complication happening were not very high,but still higher than it in the single expander skin soft-tissue expansion.
Conclusions:
1. We can use one incision for the adjacent expanders; the incision which is perpendicular with the expanders is better.
2. To stop bleeding by using the cold light source and to use grating suture can prevent complication effectively.
引文
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[4]整形外科学/王炜主编.——杭州:浙江科学技术出版社, 1999,9.
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[10] Maillard GF. McGhan style 410 anatomic breast implants. Plast Reconstr Surg. 1995,96:495-496.
[11] A Single Surgeon’s 12-Year Experience with Tissue Expander/Implant Breast Reconstruction: Part II. An Analysis of Long-Term Complications, Aesthetic Outcomes, and Patient Satisfaction Plast. Reconstr. Surg. 2006, 118:832.
[12] Jose’Mar?’a Serra-Renom, MD, PhD, Joan Fontdevila, MD, Jaume Monner, MD, and Jesus Benito, MD, PhD. Mammary Reconstruction Using Tissue Expander and Partial Detachment of the Pectoralis Major Muscle to Expand the Lower Breast Quadrants .Ann Plast Surg 2004,53: 317-321.
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[24] Stephen J. Kovach, MD,* Kim E. Koger, MD,* Bruce Klitzman, PhD, ? Gunter Germann, MD, ? and L. Scott Levin, MD*, Advantages of Minimally Invasive, Balloon-Dissector-Assisted Tissue Expander Placement: A Clinical and Experimental Study. Ann Plast Surg 2008,60:89-97.
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[26] Teimurian B, Koroll SS. Subcutaneous endoscopy and suction lipectomy. Plast Reconstr Sury, 1984,74:708-711.
[27] JM Serra. T issue expansion with endoscopy. Ann PlastS urg, 1997,38 (2): 101.
[28] Egeland, Brent, Cederna, Paul. A Minimally Invasive Approach to the Placement of Tissue Expanders. Source Seminars in Plastic Surgery.Frontiers in Endoscopic Plastic Surgery. February 2008,22(1):9-17.
[29] Jason D. Toranto, M.D. Deborah Yu, M.D. Paul S. Cederna, M.D. Endoscopic versus Open Tissue-Expander Placement: Is Less Invasive Better?. Plast. Reconstr. Surg. 2007,119:894.
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[32]郭树忠,卢丙仑,韩言.内窥镜在皮肤扩张器植人中的应用.中国美容医学杂志, 2001,(4):326.
[33]顾斌,李青峰,刘凯沈,国雄.胸部瘫痕治疗中应用内窥镜辅助扩张器置入的疗效观察.中国临床康复, 2004,8(32):7338-9.
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[2]高景恒,张晨,王志军.整形外科之精髓及学科发展方向.中国实用美容整形外科杂志, 2005,16(2).
[3]新编皮肤软组织扩张术/鲁开化,艾玉峰,郭树忠主编.——上海:第二军医大学出版社, 2007.8.
[4]整形外科学/王炜主编.——杭州:浙江科学技术出版社, 1999,9.
[5] NEUMANN C G. The expansion of an area of skin by progressive distention of a subcutaneous balloon[J]. Plast Reconstr Surg, 1957,19:124-135.
[6] RADOVAN C. Adjacent flap development using expandable silastic implants. Annual meeting, American society of plastic and reconstructive surgeon [J]. Boston M ass, 1976,30.
[7] Radovn C. Breast reconstruction aftermastectomy using the temporary expander[J]. Plast Reconstr Surg, 1982,69:195-206.
[8] Maxwell GP, Falcone PA. Eighty-four consecutive breast reconstructions using a textured silicone tissue-expander. Plast Reconstr Surg. 1992;89: 1022-1034.
[9] Spear, Scott L. M.D.; Majidian, Alexander M.D. Immediate Breast Reconstruction in Two Stages Using Textured, Integrated-Valve Tissue Expanders and Breast Implants: A Retrospective Review of 171 Consecutive Breast Reconstructions from 1989 to 1996. Volume 101(1), January 1998,pp 53-63.
[10] Maillard GF. McGhan style 410 anatomic breast implants. Plast Reconstr Surg. 1995,96:495-496.
[11] A Single Surgeon’s 12-Year Experience with Tissue Expander/Implant Breast Reconstruction: Part II. An Analysis of Long-Term Complications, Aesthetic Outcomes, and Patient Satisfaction Plast. Reconstr. Surg. 2006, 118:832.
[12] Jose’Mar?’a Serra-Renom, MD, PhD, Joan Fontdevila, MD, Jaume Monner, MD, and Jesus Benito, MD, PhD. Mammary Reconstruction Using Tissue Expander and Partial Detachment of the Pectoralis Major Muscle to Expand the Lower Breast Quadrants .Ann Plast Surg 2004,53: 317-321.
[13] Cordeiro, P. G., Pusic, A. L., Disa, J. J., McCormick, B., and VanZee, K. Irradiation after immediate tissue expander/implant breast reconstruction: Outcomes, complications, aesthetic results, and satisfaction among 156 patients. Plast. Reconstr. Surg. 2004,113:877.
[14] Barone FE. The biomechanical and histopathologic effect of surface exturing with silicone and potyurethane in tissue implantation and expansion. Plast Reconstr Surg, 1992,90:77.
[15] Marshall WR. Types of collagen in breast capsules. Ann Plast Surg, 1989, 23(3):401-403.
[16] Mustoe TA, Bartell TH, Garner WL. Physical, biomechanical, histologic, and biochiemical effects of rapid verus convertioal tissue expansion. Plast Reconstr Surg, 1989,83(4):687-690.
[17] Park C. Subfacial expansion and expanded two-flap method for microtia reconstruction, 2000,106:1473-1487.
[18] Hata Y, Hoso-kawa K, Yano K. Correction in congenital microtia using thetissue expander. Plast Reconstr Surg, 1989:84741-749.
[19]鲁延林,杨维琦,张悦安.一种新型皮肤软组织扩张器的研制.临床医药实践杂志, 2007,16(5).
[20] Rounert MA, Hofheinz H, Manassa E, et al. The beginning of a new Era in tissue expansion: self-filling osmotic tissue expander-four-year clinical experiencc. Plast Reconstr Surg, 2004,114(5):1025.
[21]张丕红,黄晓元,任利成,龙剑虹,刘雄.改良皮肤扩张器的临床应用.中华整形外科杂志, 2005,21(3):23.
[22] Argenta LC, Austad ED. Principles and techniques of tissue expansion. In: McCarthy JG, ed. Plastic Surgery. Philadelphia: WB Saunders; 1990:475-507.
[23]宋慧锋,柴家科,陈敏亮,陈宝驹,许明火,京萨,吴焱秋,梁黎明.垂直微创切口皮肤软组织扩张器置入术.中国修复重建外科杂志. 2006,20(1).
[24] Stephen J. Kovach, MD,* Kim E. Koger, MD,* Bruce Klitzman, PhD, ? Gunter Germann, MD, ? and L. Scott Levin, MD*, Advantages of Minimally Invasive, Balloon-Dissector-Assisted Tissue Expander Placement: A Clinical and Experimental Study. Ann Plast Surg 2008,60:89-97.
[25]谢玉娥,袁好军,李秀兰,王涛,常谨.微创皮肤软组织扩张器置入技术的应用研究.中国基层医药, 2003,10(11).
[26] Teimurian B, Koroll SS. Subcutaneous endoscopy and suction lipectomy. Plast Reconstr Sury, 1984,74:708-711.
[27] JM Serra. T issue expansion with endoscopy. Ann PlastS urg, 1997,38 (2): 101.
[28] Egeland, Brent, Cederna, Paul. A Minimally Invasive Approach to the Placement of Tissue Expanders. Source Seminars in Plastic Surgery.Frontiers in Endoscopic Plastic Surgery. February 2008,22(1):9-17.
[29] Jason D. Toranto, M.D. Deborah Yu, M.D. Paul S. Cederna, M.D. Endoscopic versus Open Tissue-Expander Placement: Is Less Invasive Better?. Plast. Reconstr. Surg. 2007,119:894.
[30]郭树忠,卢丙仑,韩岩.内镜在扩张器植入中的应用.中国美容医学, 2001,10(4).
[31]谢洋春,宋业光.内窥镜在整形外科应用的进展.中华整形烧伤外科杂志, 1998,14(2).
[32]郭树忠,卢丙仑,韩言.内窥镜在皮肤扩张器植人中的应用.中国美容医学杂志, 2001,(4):326.
[33]顾斌,李青峰,刘凯沈,国雄.胸部瘫痕治疗中应用内窥镜辅助扩张器置入的疗效观察.中国临床康复, 2004,8(32):7338-9.
[34] Burstein, Fernando D. M.D.; Cohen, Steven R. M.D.; Huang, Martin H. S. M.B., B.S.; Sims, Cathy A. R.N., Applications of Endoscopic Surgery in Pediatric Patients, Plastic and Reconstructive Surgery, 1998,pp1446-1451.
[35] Jose’Mar?’a Serra-Renom, MD, PhD, Eva Guisantes, MD, Taisik Yoon, MD,and Jesus Benito-Ruiz MD, PhD, Endoscopic Breast Reconstruction With Intraoperative Complete Tissue Expansion and Partial Detachment of the Pectoralis Muscle. Ann Plast Surg 2007,58:126-130.
[36]邢新,郝岚,宋建星.内窥镜技术在整形外科中的应用.中国内镜杂志, 1999,5(3).
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