- 期刊
Reconstruction of Axillary Burn Scar Contracture with Five-flap Z-plasty
使用五皮瓣Z成型術矯治燒傷後腋下疤痕臠縮
摘要
目的：腋下疤痕臠縮為大面積燒傷之常見併發症，往往造成肩關節之運動範圍限制。由於肩關節之休息姿勢為處於臠縮好發的位置，一旦腋下產生疤痕臠縮，其治療相當棘手。於此，我等提出一系列應用五皮瓣Z成型術矯治燒傷後腋下疤痕臠縮之報告。病人及方法：於1998年3月至2001年5月間，共有8例以五皮瓣Z成型術矯治燒傷後腋下疤痕臠縮之手術，吾人紀錄肩關節術前及術後外展的運動範圍度數，並加以比較分析。結果:所有的腋下疤痕臠縮皆成功的重建並癒合無手術相關死亡及傷口癒合相關併發症。肩關節術前及術後外展的運動範圍度數分別為96.3±11.6及153.1±11.66度，p值小於0.001。結論：使用五皮瓣Z成型術矯治燒傷後腋下疤痕臠縮具以下之優點：與大規模皮瓣重建手術較耗時較少、不需額外供皮處、手術技巧難度不高，其對抗續發臠縮之能力又優於一般植皮手術。術後亦不需長期副木固定。由此一系列之結果得知於特定病患使用五皮瓣Z成型術矯治燒傷後腋下疤痕臠縮為一有效之方法。
關鍵字
無資料並列摘要
Purpose: Axillary contractures are a common complication after severe burn injuries. Since the normal resting position of shoulder and axillary regions is in the contracture position, it is very difficult to prevent posthurn scar contractures of the axilla. The purpose of this study is to validate the effectiveness of five-flap z-plasty in correcting the burn scar contracture of axilla. Patients and methods: Between March 1998 and May 2001, eight procedures of five-flap z-plasty were used to release the axillary contractures after burn injury. The ranges of abductive motion of shoulder before and after the operation were recorded. The data were then collected and analyzed with paired t-test. Results: All the reconstructed axilla healed primarily with no wound associate complications. The mean of range of motion for abduction of involved shoulders before and after operation are 96.3±11.6 and 153.1±11.6 degree respectively (p＜0.001). One patient developed temporary brachial plexus palsy due to over-stretch of shoulder joint during operation and recovered spontaneously one month later. Conclusion: The five-flap z-plasty is an effective procedure for releasing burn axillary contracture in selective cases. This procedure has the advantages of (1) Less time consuming as compared with major flap operation;(2) No extra flap donor area is needed;(3) Act as flaps, less secondary contracture as compared with skin graft;(4) Not necessary for prolonged splinting after operation. In prevention of possible brachial plexus injuries, the excessive abductive stretches on shoulder should be avoided.
延伸閱讀
- 陳慧俐、黃寶螢、沈永釗、石惠美、莊文怡（2019）。提升燒傷中心疤痕重建手術護理指導成效改善專案。健康科技期刊，5(2)，1-11。https://doi.org/10.6979/TJHS.201903_5(2).0001
- Chu, T. S., Wu, C. J., Chang, C. K., Chen, C. Y., Wang, C. Y., Chou, C. Y., Chiao, H. Y., Wang, C. H., Dai, N. T., & Tzeng, Y. S. (2017). 八仙塵爆事件中大面積燒傷患者使用Meek微粒皮膚植皮合併負壓式傷口治療. 臺灣整形外科醫學會雜誌, 26(1), 73-81. https://www.airitilibrary.com/Article/Detail?DocID=a0000593-201703-201704140015-201704140015-73-81
- Hsu, Y. C., Yang, C., Chen, B. R., Huang, K. F., Lin, Y. S., Hsu, W. M., & Fang, C. L. (2004). 以早期廣泛切除及植皮來治療腋下化膿性大汗腺炎. 中華民國整形外科醫學會雜誌, 13(4), 277-283. https://doi.org/10.7096/JPSA.200412.0277
- Yeh, C. C., Lin, Y. S., Hsu, Y. C., Lin, Y. S., Yang, C., & Huang, K. F. (2008). 利用Versajet(上標 TM)水刀系統處理燒傷以減少疤痕鑾縮. 中華民國整形外科醫學會雜誌, 17(1), 35-43. https://doi.org/10.7096/JPSA.200803.0035
- 李純兒、吳佩璇（2021）。物理治療介入對於下肢踝關節全層植皮手術燒燙傷患者的下肢功能與疤痕組織之影響：個案報告。物理治療，46(4)，263-271。https://doi.org/10.6215/FJPT.202112_46(4).0004