Application of Expanded Full Thickness Skin Graft for Release of Burn Hand Contracture

利用擴張全層植皮重建燒傷後手部疤痕攣縮

陳淑賢(Shu-Hsien Chin) ； 孫宗伯(Tzong-Bor Sun0) ； 李俊達(Jiunn-Tat Lee) ； 簡守信(Sou-Hsin Chien) ； 陳明庭(Ming-Ting Chen)

《中華民國重建整形外科醫學會雜誌》 8卷2期 (1999/06) Pp. 130-136

https://doi.org/10.7096/JPRSA.199906.0009

摘要

疤痕過度增生，導致攣縮畸形，爲造成燒燙傷後功能障礙之主因。手部燒傷的治療原則重點在於穩定之軟組織覆蓋及功能之恢復，而且是費時及耗財的，可分爲手術及非手術治療，可單獨使用或合併應用。單純之切除疤痕的復發率相當高，約50%至80%，然而兼具手術及輔助性的非手術療法，則可有效地縮減疤痕的範圍及復發率。使用組織擴張器産生新的組織，來重建大面積的缺損，已被視爲有效且質優之方法。吾人報告一例使用擴張全層值皮手術，成功地重建燒傷後手部疤痕攣縮之個案。此病例之組織擴張處置於鼠蹊部有以下之優點：除供皮處之疤痕不明顯，且容易隱藏外，可提供更多多餘之皮膚及堅固之骨架支撐環境以提高組織擴張之效率；另全層皮較分層皮能抗二度攣縮，術後可不需其他輔助治療，亦能達到很好的效果；而手部之掌指關接如要達到完全之彎曲，全層皮比分層皮亦能提供較多之皮膚供當掌指關接之移動；擴張後之全層植皮可滿足此病例百分之百握力之要求。缺點如同一般之組織擴張。

並列摘要

The Management of burned hands focuses on restoration of function with stable soft tissue coverage. The overriding goal in reconstruction of a burned band is to maximize and restore function. Currently, treatment of FDP remains time-consuming and expensive. Treatments can be divided into surgical and non-surgical. These therapies can be treated alone or combined with other therapies as adjuvant therapy. Overall, surgical excision of HSc without adjuvant therapy is associated with high rate of recurrence. Recurrence rates for simple surgical excision of HSc alone vary from 50% to 80%. However, a combined program of surgical and non-surgical therapies effectively treats most contracture with or without HSc. Tissue expander is now recognized as a means of providing additional tissue for the reconstruction of large skin defects and soft tissue defects. This is a report of a case of burn hand with extension contracture and reconstructed successfully with expanded full thickness skin graft from the groin area. In this case we choose groin area as a site of expansion with the follwing advantages: (1) the excess skin over groin area and the femur bone and hip girdle which can provide good bony support for the expanders will increase the efficacy of expansion, (2) donor site with uncoupious scar which can be easily hidden, (3) FTSG compared to STSG has better resistance to secondary contracture which might not needed Jobst compression glove, (4) the flexion of metacapal joints need larger excursion of skin and prefabricated FTSG can provide a better excursion than STSG, (5) prefabricated FTSG provides excellent result in this case which full-filled the need of this patient to perfomed hundred percent gripping power with full flexion of metacarpal joints. Drawbacks of this operation share the similar possible drawbacks as other tissue expansion.

並列關鍵字

expanded full thickness skin graft ； burned hand contracture ； prefabricated tissue expansion ； hypertrophic scar.