摘要
目的探讨儿童上肢巨大黑色素痣(GCMN)完整切除后创面行背部大张中厚皮片移植,背部供皮区头皮回植的临床效果。方法选择2017年4月至2020年5月空军军医大学第一附属医院收治的16例先天性上肢GCMN患儿,其中男9例,女7例,年龄2岁7个月至12岁。巨大黑色素痣面积13 cm×11 cm~23 cm×20 cm,切除肢体GCMN皮肤后的创面用凡士林油纱布覆盖2~3 d后,用鼓式取皮机在后背切取大张中厚皮片移植,背部供皮区创面回植刃厚头皮。结果16例患儿上肢巨大黑色素痣切除及后背中厚供皮区创面植皮效果满意,无皮片坏死、成活不良等严重并发症发生。1例患儿肢体移植皮片下血浆肿形成,经开洞引流,3次换药后愈合。并行肢体和供区抗瘢痕及康复治疗,术后随访6~18个月,植皮区、供皮区无明显瘢痕增生及挛缩出现。后背及肢体植皮区皮肤色泽及弹性与创周正常皮肤较接近,肘关节、腕关节、指间关节活动不受限,患儿家长对巨大黑色素痣肢体植皮区、后背供皮区功能及外观较为满意。结论儿童先天性上肢巨大黑色素痣切除后创面行背部大张中厚皮片移植修复功能及外观较好;背部供皮区经头皮回植后无明显瘢痕形成,修复效果较佳。
Objective To investigate the clinical effect of large medium thickness skin graft on the back and scalp replantation in the back donor area after complete resection of giant congenital melanoma nevus(GCMN)in children′s upper limbs.Methods From April 2017 to may 2020,16 pediatric patients with GCMN of upper limbs were treated in the First Affiliated Hospital of Air Force Military Medical University,including 9 males and 7 females,aged from 2 years to 7 months to 12 years.Giant melanoma nevus area 14 cm×11 cm-23 cm×20 cm,the wound after removing the skin of giant melanocytic nevus of the limb was covered with vaseline oil gauze for 2-3 days,and then a large medium thickness skin graft was cut on the back with a drum skin extractor for transplantation.The wound in the back skin donor area was replanted with a blade thick scalp.Results The effect of excision of giant nevus of upper limb and skin grafting on the wound of back medium thickness donor area in 16 pediatric patients was satisfactory,and there were no serious complications such as skin necrosis and poor survival.Plasma swelling was formed under the skin graft of one child′s limb,which healed after opening and drainage and three dressing changes.Anti-scar and rehabilitation treatment was performed on the limb and donor site.The patients were followed up for 6-18 months.There was no obvious scar hyperplasia and contracture in the skin graft area and donor area.The skin color and elasticity of the back and limb skin graft area were close to the normal skin around the wound,and the activities of elbow joint,wrist joint and interphalangeal joint were not limited.The parents of the pediatric were satisfied with the function and appearance of the limb skin graft area and back skin donor area of giant nevus.Conclusions The function and appearance of large medium thickness skin graft on the back after excision of congenital giant nevus of upper limb in pediatric are better;There is no obvious scar formation after scalp replantation in the back donor area,and the repair effect is better.
作者
计鹏
胡大海
曹涛
张智
赵海洋
梁敏
佟琳
张月
陶克
Ji Peng;Hu Dahai;Cao Tao;Zhang Zhi;Zhao Haiyang;Liang Min;Tong Lin;Zhang Yue;Tao Ke(Department of Burns and Cutaneous Surgery,Burns Center of PLA,the First Affiliated Hospital of Air Force Military Medical University,Xi′an 710032,China)
出处
《中国医师杂志》
CAS
2021年第12期1764-1768,共5页
Journal of Chinese Physician
基金
国家自然科学基金(81871561)
关键词
痣
色素
皮肤移植
儿童
Nevus,pigmented
Skin transplantation
Child
