目的:探讨应用皮肤软组织扩张术治疗四肢关节部位瘢痕的方法及临床效果.方法:根据四肢关节部位瘢痕的挛缩情况、位置、及面积大小,Ⅰ期选用挛缩瘢痕松解改形、长方形或肾形扩张器纵向交错置入、40℃热盐水注射扩张与功能锻炼交替进行的方法提高正常皮肤的有效扩张.扩张达标后扩张皮瓣Ⅱ期采用松解纤维囊、推进滑行、易位成形或菱形瓣转移的方法促进扩张皮瓣的合理利用.矫正畸形后根据扩张皮瓣大小适度切除瘢痕,扩张皮瓣修复方法以推进滑行、易位成形为主,以减少并发症的发生.结果:自2006年3月～2010年8月采用上述多方法联合临床应用25例.发生扩张器外露1例,Ⅱ期术后1例小部分瘢痕残留,1例扩张皮瓣长度不够设计菱形瓣转移张力过大,皮瓣远端血运障碍导致愈合不良,其余病例瘢痕切除完全,畸形矫正彻底,功能正常,外形美观.结论:在关节周围有充足可扩张正常皮肤的情况下,通过多方法联合应用可提高正常皮肤的有效扩张和扩张皮瓣的合理利用,有助于关节功能的恢复和外形的美观,减少并发症的发生.%Objective To discuss the method and effect of treating scar in limbs arthrosis using expandor. Methods In the first stage, webbed scar solution,rectangle or kidney shape expandor insertion,40℃ warm saline injection and functional exercise were practiced alternately to expand skin sufficiently according to the location,type and area of scar in limbs arthrosis,during the second stage,the expanded flap was transferred through rotation,advancement or designed as Z or rhombus shape to repair the defects after scar resection,it was a good way to reduce the complication. Results From March 2006 to August 2010,25 cases were performed by two stages operation mentioned above,one expandor exposed,dyshemia was occurred in the distal end of one flap due to hypertension and one case remained a little scar, the rest flaps were survived well and recovered to a natural appearance. Conclusions The expanded skin flap is an idea choice for the function and appearance recovery of arthrosis on the premise of effectively expand and utilize.
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