徒手牵引外扩张直接切除缝合术医治体表中小面积瘢痕

徒手牵引外扩张直接切除缝合术医治体表中

小面积瘢痕

张新合，杨新蕾，郭志谦，江碧川，雷蕾

【摘要】 目的 探讨徒手牵引外扩张瘢痕直接切除缝合术医治体表中小面积瘢痕的临床成效。方式 对21例体表中小面积瘢痕患者，第一让患者或其家眷使劲徒手牵拉体表瘢痕以扩张周围正常皮肤，每次持续3～10 min，天天20次左右。待瘢痕能够明显提起，边缘正常皮肤能在瘢痕下对合时行一次性切除瘢痕直接缝合术排除瘢痕。结果 21例患者共医治26处瘢痕，修复面积最大18 cm×6 cm，所有患者均取得有效医治，无并发症。结论 徒手牵引外扩张瘢痕直接切除缝合术医治体表中小面积瘢痕方式简单，创伤小，切口瘢痕少，成效好，无并发症。

【关键词】 外扩张；瘢痕；牵引

Abstract： Objective To study the clinical application of skin dilation directly pulled by hands in treating scars on body surface. Methods Twenty

one patients with 26 scars

treated by skin dilation directly pulled by hands in our department since the end of 2003 were reviewed retrospectively. The treating approach was introduced as following. First, the

patients or their relatives were asked to pull the scars by hands for 3-5 minutes every time (20 times a day). The scars would be excised when the normal skin around the scars could touch each other side by side. Results All the 26 scars in the 21 patients were effectively treated without any complications. The maximum of the repaired surface was up to 18×6 The clinical application of skin dilation directly pulled by hands in treating scars on the body surface shows great promise with simple method and without any complications.

Key words： skin dilation; scar; pulling

体表瘢痕常伴有不同程度的瘙痒、疼痛等不适，而且不同程度地阻碍患者面貌及美观，常给患者带来严峻的躯体不适及心理障碍。医治包括抗瘢痕医治、激素瘢痕内注射医治及各类美容医治，但上述方式仅能改善疼痛、瘙痒等病症，瘢痕去除不完全，不能有效改善外观。分次切除手术次数多、创伤大、费用高。植皮手术易造成医源性瘢痕，皮片颜色与周围不一致，皮片周围切口瘢痕长等缺点。本研究采纳徒手牵拉外扩张瘢痕周围正常皮肤，直接切除瘢痕缝合，具有方式简单、创伤小、痛楚少、切口瘢痕短、费用低、医治时刻短、可门诊手术医治、成效良好持久等优势。现总结报告如下。

1 临床资料

1．1 一样资料

本组21例，男15例，女6例。年龄4．5～37岁，平均22岁。瘢痕缘故：烧伤17例，外伤3例，感染1例。瘢痕性质：增生性19例、增生伴挛缩2例。瘢痕面积：大多呈不规那么椭圆形，较宽的索条状，最大面积18 cm×6 cm。瘢痕部位：面颈部瘢痕5例，四肢瘢痕11，胸腹部瘢痕8例，腰背部瘢痕2例。头部、足底及手掌部瘢痕不适合此法。

1．2 方式

徒手牵拉外扩张

单手或双手沿瘢痕纵向持住向外持续牵拉，依照患者的疼痛感受不同调剂拉力，每次3～10 min。如患者感疼痛明显，可用毛巾、棉垫等做衬垫。天天牵拉20次左右，每两次至少距离15 min。瘢痕周围皮肤慢慢被扩张、拉长，一样2周～2个月，牵拉到瘢痕周围对侧皮肤可慢慢于瘢痕下对接为止。

1．2．2 手术切除瘢痕