烧伤后瘢痕性脚趾挛缩的外科治疗

E. K. Ibragimov, A. Davlatov, M. Malikov, M. Khaydarov, N. Khamidov, N. A. Makhmadkulova
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引用次数: 1

摘要

目的:探讨烧伤后瘢痕挛缩的外科治疗方法。方法:对72例3 ~ 15岁儿童烧伤后瘢痕延伸挛缩的治疗结果进行分析。男生38例(52.8%),女生34例(47.2%)。14例(19.4%)患儿双足均受影响,共86例患儿有延伸挛缩。在大多数病例(n=53, 73.6%)的儿童(62英尺)中,向近端延伸的回缩疤痕也会引起踝关节的延伸挛缩。结果:在所有病例中,根据Hirshowitz的说法,采用改良的z -成形术(蝴蝶瓣)技术来纠正前踝关节的瘢痕挛缩。89.5%的患者(77英尺)在局部皮瓣重建后,软组织缺损(范围,6-30平方厘米)仍然存在。缺损用全层自体皮片覆盖。在本病例中,32.6%(28英尺)暴露的肌腱和皮神经被周围的皮下组织和筋膜初步覆盖,作为血液供应来源。局部皮瓣手术重建16(18.6%)脚轻度瘢痕挛缩。21例(24.4%)进行了肌腱-关节结构重建。86只手术足中有7只出现术后早期并发症,占8.1%。在所有病例中,并发症包括局部皮瓣边缘坏死和移植的全层皮肤移植物,分别在4英尺(4.6%)和3英尺(3.5%)处观察到。在所有病例中,移植全层皮肤移植被注意到;无挛缩完全复发。由于8例(9.3%)患儿在术后后期(6-10年)出现躯体生长,需要进行多次矫正手术。结论:小儿烧伤性脚趾挛缩需要对皮肤和软组织进行手术干预。不幸的是,病理过程几乎总是伴随着皮肤和软组织的缺乏,需要皮肤移植。从长远来看,需要反复进行矫正手术。关键词:烧伤后挛缩,自体皮肤移植,足部挛缩,局部皮瓣手术。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
SURGICAL MANAGEMENT OF POST-BURN SCAR EXTENSION CONTRACTURES OF THE TOES
Objective: To study surgical management of post-burn scar extension contractures of the toes. Methods: The treatment outcomes of 72 children with post-burn scar extension contractures of the toes between the ages of 3-15 were analysed. There were 38 boys (52.8%), girls – 34 (47.2%). In 14 (19.4%) children, both feet were affected, with a total of 86 feet with extension contracture. In most cases (n=53, 73.6%) of children (62 feet), retracting scars extending proximally also caused extension contracture of the ankle joint. Results: In all cases, a modified Z-plasty (butterfly flap) technique, according to Hirshowitz, was used to correct scar contracture of the anterior ankle. In 89.5% of patients (77 feet) after reconstruction using a local flap, soft tissue defects (range, 6-30 cm2) remained. The defects were covered with full-thickness autologous skin grafts. In this case, in 32.6% (28 feet), the exposed tendons and cutaneous nerves were preliminarily covered by the surrounding subcutaneous tissue and fascia used as a blood-supplying source. Local flap surgery helped reconstruct mild scar contracture in 16 (18.6%) feet. In 21 (24.4%) cases, tendon-articular structures were reconstructed. Complications in the early postoperative period were observed in 7 out of 86 operated feet, which amounted to 8.1%. In all cases, complications included marginal necrosis of local flaps and transplanted full-thickness skin grafts observed in 4 feet (4.6%) and 3 (3.5%) feet, respectively. In all cases, engrafting of a full-thickness skin graft was noted; and there was no complete recurrence of contracture. Due to the somatic growth of children in 8 cases (9.3%) in the late postoperative period (after 6-10 years), repeated corrective surgical procedures were required. Conclusion: In children, burn contractures of the toes require surgical intervention on the skin and soft tissue. Unfortunately, the pathological process is almost always accompanied by a lack of skin and soft tissue, requiring skin grafts. In the long term, there is a need for repeated corrective surgical interventions. Keywords: Post-burn contracture, skin autografts, foot contracture, local flap surgery.
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