拉杆式皮肤扩展器在股前外侧皮瓣术后缺损中的应用

doi:10.3877/cma.j.issn.1673-9450.2023.02.009

中华损伤与修复杂志(电子版) ›› 2023, Vol. 18 ›› Issue (02) : 144 -147. doi: 10.3877/cma.j.issn.1673-9450.2023.02.009

论著

拉杆式皮肤扩展器在股前外侧皮瓣术后缺损中的应用

李晓光¹, 周杰玉¹, 刘凯¹, 火子榕¹, 谭皓月¹, 何悦², 张治华¹, 王振涛¹^,^†(

), 汪照炎¹^,^†(

)

^1. 200011　上海交通大学医学院附属第九人民医院耳鼻咽喉头颈外科；200125　上海交通大学医学院耳科学研究所　上海市耳鼻疾病转化医学重点实验室
^2. 200011　上海交通大学医学院附属第九人民医院　口腔医学院口腔颌面头颈肿瘤科

收稿日期:2022-09-14 出版日期:2023-04-01
通信作者: 王振涛, 汪照炎

The draw-bar skin stretcher used for repairing the wound area of the anterolateral thigh flap

Xiaoguang Li¹, Jieyu Zhou¹, Kai Liu¹, Zirong Huo¹, Haoyue Tan¹, Yue He², Zhihua Zhang¹, Zhentao Wang¹^,^†(), Zhaoyan Wang¹^,^†()

^1. Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People′s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China; Ear Institute, Shanghai Jiao Tong University School of Medicine, Shanghai Key Lab, Shanghai 200125, China
^2. Department of Oral Maxillofacial-Head and Neck Oncology, Shanghai Ninth People′s Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China

Received:2022-09-14 Published:2023-04-01
Corresponding author: Zhentao Wang, Zhaoyan Wang

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引用本文：

李晓光, 周杰玉, 刘凯, 火子榕, 谭皓月, 何悦, 张治华, 王振涛, 汪照炎. 拉杆式皮肤扩展器在股前外侧皮瓣术后缺损中的应用[J]. 中华损伤与修复杂志(电子版), 2023, 18(02): 144-147.

Xiaoguang Li, Jieyu Zhou, Kai Liu, Zirong Huo, Haoyue Tan, Yue He, Zhihua Zhang, Zhentao Wang, Zhaoyan Wang. The draw-bar skin stretcher used for repairing the wound area of the anterolateral thigh flap[J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2023, 18(02): 144-147.

目的

探讨拉杆式皮肤扩展器在游离股前外侧皮瓣术后缺损的临床应用效果。

方法

回顾性分析2020年1月至2021年1月上海交通大学医学院附属第九人民医院收治的30例患者，均行股前外侧皮瓣修复，供区创面均不能通过直接拉拢缝合，采用拉杆式皮肤扩展器进行皮肤扩张修复创面，术后观察创面愈合情况及相关并发症。

结果

30例患者均获得随访，随访时间5~12(8.5±3.5)个月。其中24例患者大腿供区创面顺利痊愈，局部无显著疤痕增生，下肢活动恢复正常。1例患者出现局部脂肪液化，5例患者出现张力性水泡及皮缘少量坏死，给予积极换药后创面愈合。

结论

应用拉杆式皮肤扩展器可治疗股前外侧皮瓣供区难以直接拉拢缝合的创面，可避免术中取皮植皮或转移局部组织瓣，减少二次损伤，术后供区肢体活动不受影响，但仍需严格掌握其适应症。

关键词: 皮肤牵张, 股前外侧皮瓣, 创面修复

Objective

To explore the application value of draw-bar skin stretcher used for repairing the wound area of the anterolateral thigh flap.

Methods

Retrospective analysis was performed on 30 patients admitted to Shanghai Ninth People′s Hospital, Shanghai Jiao Tong University School of Medicine from January 2020 to January 2021, all of whom received anterolateral thigh flap repair. The donor site wounds could not be directly closed and sutured, and the wound healing and related complications were observed after using draw-bar skin stretcher.

Results

All 30 patients were followed up for 5-12 months, with an average of (8.5±3.5) months. Among them, 24 patients recovered smoothly on the thigh donor site without significant local scar hyperplasia, and their lower limb activities returned to normal. Local fat liquefaction occurred in 1 patient, tension blister and a small amount of skin edge necrosis occurred in 5 patients. After active dressing change, the wound healed.

Conclusion

The draw-bar skin stretcher can be used to treat the wound that is difficult to be directly closed and sutured at the donor site of anterolateral thigh flap, avoid skin grafting or local tissue flap transfer during operation, and reduce secondary injury. The limb activity of the donor site is not affected after operation, but the indications should be strictly controlled.

Key words: Skin stretching, Anterolateral thigh flap, Wound healing

图1 拉杆式皮肤扩展器装置。A示钩子模块：钩针单元可以通过一个连接销插入针的顶端孔进行组装；B示持针器：这些持针器可以通过凹槽接合针；C示弹簧模块：显示创缘的张力，有三个音阶代表低、中、高张力；D示针杆：设备张力较小时，伤口可以完全关闭针杆，沿针杆推动弹簧模块和针夹，以此可以缩小创面

图2 拉杆式皮肤扩展器应用于股前外皮瓣供区创面的修复。A示股前外侧皮瓣制备后供区创面，大小8 cm×15 cm；B示拉杆式皮肤扩展器术中牵引中；C示供区创面愈合1年后随访

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