摘要
目的回顾分析应用分次切除联合皮肤扩张法治疗儿童头部巨痣的可行性及效果。方法回顾性分析2018年1月至2023年1月,福建省泉州市华侨大学附属妇儿医院整形外科收治的儿童先天性头部巨痣患儿的临床资料。患儿均采用分次切除联合皮肤扩张法修复,治疗分2期或3期,一期手术,根据病变大小,确定扩张器容量,于头部埋置100~400 mL长方形扩张器,定期注水扩张,扩张频率1~2次/周,一期术中切除长条状病变(宽约2.0 cm),切口直接拉拢缝合,切除部分远端部分巨痣。二期手术,取出扩张器,切除头部巨痣,根据黑痣的大小、形状设计轴型皮瓣,修复头部巨大缺损。三期手术对转移的皮瓣进行修整。术后随访观察治疗效果、并发症发生情况、皮瓣转移后的血运情况。结果本组共纳入6例患儿,全部为男性病例,年龄1~15岁。其中5例行二期手术,1例行三期手术。一期术后扩张时间12~53周,平均36周。二期手术中切取的扩张皮瓣面积7 cm×6 cm~12 cm×10 cm,术后4 d有1例皮瓣的远端出现了静脉回流障碍,予针刺放血及拆除部分缝线及换药处理后愈合良好。经过二期和三期手术完成治疗的患儿,术后随访至少6个月,巨痣均无复发,所有的扩张皮瓣颜色、质地与头部正常皮肤接近,且未发现皮瓣有明显挛缩,头部供区瘢痕亦不明显。结论应用分次切除联合皮肤扩张法治疗儿童头部巨痣,效果可靠,并发症少,减少扩张次数及扩张量,值得临床推广。
Objective To review the feasibility and effect of fractional resection combined with skin expansion in the treatment of large nevus of head in children.Methods The clinical data of children with congenital giant nevus admitted to the orthopedic Department of Women and Children's Hospital Affiliated to Huaqiao University in Quanzhou,Fujian Province from January 2018 to January 2022 were retrospectively analyzed.The treatment was divided into two or three phases.In the first phase,the dilator capacity was determined according to the size of the lesion.A rectangular dilator of 100-400ml was buried in the head,and the dilator was expanded with regular water injection once or twice a week,and the long strip lesions(about 2.0cm wide)were removed during the first phase.The incision was directly drawn and sutured,and part of the distal part of the giant nevus was removed.In the second stage of operation,the dilator was removed,the giant nevus of the head was removed,and the axial flap was designed according to the size and shape of the nevus to repair the huge head defect.The transferred flap was repaired in the third stage.Postoperative follow-up was conducted to observe the therapeutic effect,complications and blood flow after flap transfer.Results A total of 6 children were included in this group,all male cases,aged 1~15 years old.Among them,5 underwent the second stage operation and 1 underwent the third stage operation.The first stage postoperative dilation lasted from 12 to 53 weeks,with an average of 36 weeks.The expanded flap was 7 cm×6 cm~12 cm×10 cm in the second stage of operation.There was 1 case with venous return obstruction at the distal end of the flap 4 days after operation,and the flap healed well after acupuncture,bloodletting,partial suture removal and dressing change.After the completion of the second and third stage of surgery,the children were followed up for at least 6 months,and no recurrence of giant nevus was found.The color and texture of all expanded flaps were close to normal skin on the head,and no obvious contracture of the flap was found,and scar in the donor area of the head was not obvious.Conclusion The treatment of large nevus of head in children by fractional resection combined with skin dilation has reliable effect,fewer complications,less dilation times and volume,and is worthy of clinical promotion.
作者
刘长江
汪城河
林东福
吴雅莹
蔡加滨
余淑萍
苏振民
林文雄
LIU Chang-jiang;WANG Cheng-he;LIN Dong-fu;WU Ya-ying;CAI Jia-bin;YU Shu-ping;SU Zhen-min;LIN Wen-xiong(Department of Plastic Surgery,Women's and Children's Hospital Affiliated to Huaqiao University,Fujian Province,362000,China)
出处
《中国医疗美容》
2024年第4期31-34,共4页
China Medical Cosmetology
关键词
扩张器
儿童头部巨痣
分次切除
轴型皮瓣
Expander
Giant nevus in children
Fractional excision
Axial flap
