旋肩胛动脉穿支皮瓣在烧伤后重度腋窝瘢痕挛缩畸形整形修复治疗中的应用

doi:10.3877/cma.j.issn.1673-9450.2024.04.004

目的

总结旋肩胛动脉穿支皮瓣在烧伤后重度腋窝瘢痕挛缩畸形功能重建中的应用经验。

方法

2015年1月至2023年6月，首都医科大学附属北京积水潭医院烧伤科收治烧伤后重度腋窝瘢痕挛缩畸形患者38例，其中男25例，女13例，年龄5～48岁。术前患肢肩关节外展角度为20°～70°。29例为单侧腋窝瘢痕挛缩，9例为双侧腋窝瘢痕挛缩。对患者进行手术瘢痕松解，并采用旋肩胛动脉穿支皮瓣进行功能重建修复治疗。其中旋肩胛动脉横支供血的肩胛皮瓣1个，降支供血的肩胛旁皮瓣34个，含横支和降支的肩胛双叶皮瓣12个。采用Constant-Murley评分和Neer评分评估术前、术后2周及术后6个月患者肩关节活动范围及功能。

结果

38例患者术后肩关节活动范围及功能均明显改善。术前、术后2周及术后6个月Constant-Murley评分分别为(14.28±8.15)分、(41.17±9.17)分、(39.37±11.47)分，Neer评分分别为(12.58±7.25)分、(39.67±9.87)分、(37.39±12.48)分。术后随访6个月～3年，肩关节活动功能良好，外展角度均大于90°，均未再次出现腋窝瘢痕挛缩。

结论

采用旋肩胛动脉穿支皮瓣进行腋窝瘢痕挛缩畸形的功能修复，供区损伤小，修复效果良好。

关键词: 旋肩胛动脉, 穿支皮瓣, 烧伤瘢痕, 腋窝瘢痕挛缩, 双叶皮瓣

Objective

To summarize the clinical experience of circumflex scapular artery perforator flap in functional reconstruction of severe axillary cicatricial contracture after burn.

Methods

From January 2015 to June 2023, 38 patients with severe post-burn axillary cicatricial contracture were treated in Department of Burns, Beijing Jishuitan Hospital, Capital Medical University, including 25 males and 13 females aged 5 to 48 years. The joint abduction angle of the affected shoulder ranged from 20° to 70° before surgery. There were 29 cases of unilateral axillary cicatricial contracture and 9 cases of bilateral axillary cicatricial contracture. Surgical cicatricial contracture release was performed, and functional reconstruction and repair was performed with circumflex scapular artery perforator flap, including one scapular flap with blood supply from the transverse branch of circumflex scapular artery, 34 parascapular flaps with blood supply from the descending branch, and 12 scapular bilobate flaps with transverse branch and descending branch. The Constant-Murley score and Neer score were used to evaluate the range of motion and function of the shoulder joint in patients before surgery and at 2 weeks and 6 months after surgery.

Results

The range of motion and function of the shoulder joint significantly improved after surgery in 38 patients. Before surgery and at 2 weeks and 6 months after surgery, the Constant Murley scores was (14.28 ± 8.15), (41.17 ± 9.17) and (39.37 ± 11.47) respectively; the Neer scores was (12.58 ± 7.25), (39.67 ± 9.87) and (37.39 ± 12.48) respectively. The shoulder joint mobility was improved, and the joint abduction angle were all larger than 90°. There was no axillary cicatricial contracture recurrence in all patients.

Conclusion

The effect of circumflex scapular artery perforator flap for functional repair of axillary cicatricial contracture deformity is good, with little damage in donor area.

Key words: Circumflex scapular artery, Perforator flap, Burn scar, Axillary cicatricial contracture, Bilobate flap

图1 采用肩胛双叶皮瓣修复大面积烧伤后右侧腋窝瘢痕挛缩畸形。A示术前腋窝瘢痕挛缩背面观；B示术前腋窝瘢痕挛缩正面观；C示双叶皮瓣设计；D示腋窝瘢痕松解后掀起双叶皮瓣；E示双叶皮瓣转移后背面观；F示双叶皮瓣转移后正面观；G示术后6个月，患肢肩关节外展功能改善

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Application of circumflex scapular artery perforator flap in the plastic repair of severe axillary cicatricial contracture deformity after burn

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Application of circumflex scapular artery perforator flap in the plastic repair of severe axillary cicatricial contracture deformity after burn