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目的探讨颈部烧伤瘢痕挛缩的临床治疗措施。方法回顾分析我科自2005年1月至2009年12月以来收治的颈部烧伤瘢痕挛缩39例患者的临床资料。结果本组39例患者的手术植皮和皮瓣全部成活,切口一期愈合。随访1～7年,患者颈部后仰和左右转动活动正常,外形满意,未再形成瘢痕挛缩。结论严重颈部烧伤往往伴有吸入性损伤,烧伤早期积极进行创面处理,手术时机尽可能提前,在自体皮源充足条件下,优先考虑功能部位的创面修复。尽可能移植全厚皮,有利于抑制瘢痕增生、颈部功能恢复。术后采用抗挛缩措施及功能锻炼可减少瘢痕挛缩的发生或减轻瘢痕挛缩的程度。充分的术前锻炼可降低手术难度,提高手术效果。术后积极进行功能部位的被动和主动锻炼可使手术中未能完全松解部分继续松解,使皮瓣自然扩张,并防止再挛缩及黏连。
Objective To investigate the clinical treatment of scar contracture in cervical burn. Methods The clinical data of 39 patients with cervical scar contracture admitted to our department from January 2005 to December 2009 were retrospectively analyzed. Results The 39 cases of skin grafts and flaps all survived, incision healed. Follow-up 1 to 7 years, the patient’s neck back and left and right rotation activities were normal, satisfactory shape, no further scar contracture. Conclusion Severe cervical burn is often accompanied by inhalation injury. In the early stage of burn, active wound treatment is performed. The timing of operation should be advanced as soon as possible. In the condition of adequate autologous skin source, functional wound repair should be given priority. As much as possible transplantation of full-thickness skin, is conducive to inhibiting scar hyperplasia, neck function recovery. Postoperative anti-contracture measures and functional exercise can reduce the occurrence of scar contracture or reduce the degree of scar contracture. Adequate preoperative exercise can reduce the difficulty of surgery and improve the surgical results. Active postoperative active part of the passive and active exercise can not completely loosen the part of the operation to continue to loosen the natural expansion of the flap and prevent further contractures and adhesions.