Objective: To investigate the effect of skin soft tissue expansion on repair of large area of scars on extremities. Methods: Twenty-five patients with large area of scars on extremities were admitted to our department from June 2007 to October 2014. There were 14 males and 11 females, aged 4 to 36 years. Operations were performed under local infiltration anesthesia or general anesthesia. In the first stage, 1 to 5 cylindrical expanders with capacities of 250 to 600 mL were placed at left or right sides or at upper or lower parts of the scars. In the second stage, scars of 21 patients were repaired with expanded transverse propulsive and lateral flaps, and scars of 4 patients were repaired with expanded perforator flaps whose pedicles were perforators of brachial artery, superior ulnar collateral artery, or posterior interosseous artery according to areas and shapes of the scars. The secondary wound areas ranged from 13 cm×7 cm to 34 cm×18 cm after dissolution or excision of scars. The areas of flaps ranged from 13 cm×7 cm to 20 cm×12 cm. The donor sites were sutured directly. The flaps after operation and follow-up of patients were observed and recorded. Results: All expanded flaps survived after operation. And the superficial distal part of flap whose pedicle was perforator of posterior interosseous artery in one patient was with necrosis, and other flaps survived well. During follow-up of 3 to 15 months after operation of the second stage, color and texture of flaps were similar to surrounding skin, while extremities of donor sites were thinner and auxiliary incisional scars formed after expansion. Conclusions: Expanded flap is a good way to repair large area of scar on extremities. Bilateral skin of scar is the first choice of donor site of expanded flap. If there isn't enough skin for expanding on bilateral sides, expanded perforator flap designed at upper or lower part of the scar is another choice to repair the scar.
目的：探讨皮肤软组织扩张术修复四肢大面积瘢痕的效果。 方法：2007年6月—2014年10月，笔者科室收治25例四肢大面积瘢痕患者，其中男14例、女11例，年龄4～36岁。手术在局部浸润麻醉或全身麻醉下进行，Ⅰ期在瘢痕的左、右侧或上、下端放置250～600 mL圆柱形扩张器1～5个。Ⅱ期根据瘢痕面积及形状，21例患者采用横向推进扩张皮瓣修复瘢痕，4例患者采用以肱动脉、尺侧上副动脉、骨间后动脉穿支为蒂的扩张穿支皮瓣修复。瘢痕松解切除后继发创面面积13 cm×7 cm～34 cm×18 cm，皮瓣面积13 cm×7 cm～20 cm×12 cm。供瓣区直接拉拢缝合。观察并记录术后皮瓣成活情况及随访情况。 结果：术后扩张皮瓣全部成活，其中1例以骨间后动脉穿支为蒂的扩张皮瓣远端浅层坏死，其余皮瓣存活良好。Ⅱ期术后随访3～15个月，皮瓣颜色、质地与周围皮肤相近，扩张后供区四肢变细且有辅助切口瘢痕形成。 结论：扩张皮瓣是修复四肢大面积瘢痕的良好方法。瘢痕侧方皮肤是设计扩张皮瓣的首选位置，如瘢痕侧方无足够皮肤可供扩张，可在瘢痕上、下端设计扩张穿支皮瓣进行修复。.
Keywords: Cicatrix; Dilatation; Extremities; Surgical flaps.