Tissue Expansion in Children

組織擴張器於孩童之應用

楊超智(Chao-Chih Yang) ； 李俊達(Jiunn-Tat Lee) ； 鄭立福(Li-Fu Cheng) ； 王健興(Chien-Hsing Wang) ； 孫宗伯(Tzong-Bor Sun) ； 簡守信(Sou-Hsin Chien)

《臺灣整形外科醫學會雜誌》 19卷4期 (2010/12) Pp. 299-309

https://doi.org/10.7096/TJTSPS.201012.0299

摘要

背景：
組織擴張器之運用讓整形外科醫師能夠以相似顏色、厚度及結構之組織達到功能以及美觀上的重建。在過去這三十幾年來已經變成主要的重建工具之一，也廣泛受到應用。組織擴張器在孩童之應用不但可行，且無礙孩童之日常生活作息。
目的及目標：
本研究旨在回顧及評量慈濟醫院利用組織擴張器於孩童族群重建之臨床應用結果。
材料及方法：
我們搜集慈濟醫院從1995年7月至2009年8月期間，總共有12位孩童。包含8位男性及4位女性，年齡從10個月大至16歲。這些孩童總共接受了20次手術，植入了32個組織擴張器。其中16個置放於胸部，6個置放於頭皮，7個置放於大腿，2個置放於上臂以及1個置放於頸部。利用組織擴張來進行重建的原因有4例是因爲灼傷疤痕癴縮，2例是因爲灼傷造成部份禿頭，2例是因爲連體嬰欲進行分割，淋巴水腫接受重建、惡性血管內膜瘤術後重建、動靜脈畸形重建、外傷疤痕造成部份禿頭各1例。
結果：
所有的孩童順利的承受了整個組織擴張的療程，但是其中有3個組織擴張器因爲外露而必須移除。另一位孩童遭遇了傷口感染，經安排清創後，組織擴張器必須移除且療程被迫中止。有一位孩童歷經了兩次傷口邊緣組織壞死，經清創、再縫合，組織擴張療程於傷口癒合後繼續進行。整體併發症爲18.75%，12個孩童中有11個最終達成良好的重建結果。
結論：
組織擴張器於孩童族群重建應用之併發症與成人族群相似。孩童可以順利的接受整個重建過程，且組織擴張器亦可安然承受孩童的日常活動。只要慎選病患、審慎的術前術後評估計劃以及嚴密的技術，組織擴張器可以協助整形外科醫師達成良好的重建結果。

並列摘要

Background:
Tissue expansion has allowed plastic surgeons to achieve both functional and aesthetic reconstructive goals with tissues of similar color, thickness, and texture. It has become a major modality in reconstruction and has gained widespread application in the past 30 years. Tissue expansion is particularly applicable in the pediatric population as it is well tolerated during their daily activities.
Aim and Objective:
Clinical application of tissue expansion for reconstruction in the pediatric population at Tzu-Chi hospital was reviewed and the results are delineated.
Materials and Methods:
A retrospective study was performed from July 1995 to August 2009. There were 12 patients who had undergone 20 surgical procedures. A total of 32 tissue expanders were placed. There were 8 males and 4 females, with their ages ranging from 10 months to 16 years old. The indications for tissue expansion were burn scar contracture in 4 patients, burn scar alopecia in 2 patients, a pair of xipho-omphalopagus conjoined twins for separation, 1 patient with lymphedema receiving scrotal area reconstruction, 1 patient with widely excised malignant hemangioendothelioma, 1 patient with traumatic scar alopecia and 1 patient with residual arterio-venous malformation. The numbers and location of tissue expanders implanted were; 16 in the chest, 6 in the scalp, 7 in the thigh, 2 in the forearm and 1 in the neck. The complication rates and the clinical results were analyzed to evaluate the outcome of tissue expansion in this group of patients.
Results:
All patients tolerated the expansion procedure well either on an outpatient or inpatient basis. Tissue expander extrusion that necessitated removal occurred 3 times. One case developed wound infection. Debridement was carried out, the expander was removed and the expansion procedure was postponed. A total of 4 tissue expanders were removed.
Two episodes of partial skin necrosis at the wound edge occurred in one patient. The wound was debrided and primary wound closure was done. The expansion course continued smoothly once the wound had healed completely. The overall complication rate was 18.75%. Eleven out of 12 children ultimately achieved fair to good results.
Conclusion:
Tissue expansion in the pediatric population has a similar complication rate when compared to adults. Children tolerate the procedure well and the tissue expander can well withstand the child's daily activities. With proper patient selection, thorough perioperative planning and meticulous technique, tissue expansion provides healthy tissues for surgeons to achieve a good reconstructive result with minimal donor site morbidity in children.

並列關鍵字

tissue expansion ； children