Objective: To explore the application effect of sustainable skin-stretching device in scalp and soft tissue defect. Methods: From June 2017 to January 2020, 5 patients (3 males and 2 females, aged 31-57 (38.0±2.1) years) with large area of scalp and soft tissue defect and skull exposure were admitted to Department of Reparative and Reconstructive Surgery of the Second Hospital of Dalian Medical University. The wound area ranged from 16.0 cm×8.0 cm to 18.0 cm×12.0 cm. The sustainable skin-stretching device was installed after debridement operation for scalp wound. The wound was stretched from the 3rd day after installation of the device, at a basic speed of 1 mm/d and finished for 3 times on average. During stretching, close attention was paid to the changes in blood flow of the wound margin and the subjective feeling of the patients. When the result was negative in the squeezing and pinching test for wound margin after stretching, the further stretching was stopped, the final stretching state was maintained for 3 days, and the wounds were sutured directly. The wound healing during stretching of sustainable skin-stretching device and the occurrence of complications were observed. The rest wound areas after stretching for 5, 10, 15, and 20 days were measured. The wound healing and hair growth were observed during follow-up. Results: All the wounds of 5 patients was sutured directly after stretching for 19-23 d. There was no tension blister on the margin of wounds during stretching, and the margin of wounds healed well after being sutured without skin necrosis. After stretching treatment for 5-20 d, the wound areas were gradually decreased. During follow-up of 2-11 (4.5±1.5) months, the elasticity, color, feeling, and regenerated hair growth of the stretched scalp tissue were close to those of the surrounding normal skin tissue. The linear scar formed on the margin of wounds, but no scar formed on the wounds. Conclusions: The application of sustainable skin-stretching device can reduce the difficulty in repairing scalp and soft tissue defect, with the regenerated hair growing well after treatment, which is worthy of clinical promotion.
目的： 探讨可持续型皮肤牵张器在头皮及软组织缺损中的应用效果。 方法： 2017年6月—2020年1月，大连医科大学附属第二医院骨与软组织修复重建外科收治5例大面积头皮及软组织缺损伴颅骨外露患者，其中男3例、女2例，年龄31～57(38.0±2.1)岁，创面面积为16.0 cm×8.0 cm～18.0 cm×12.0 cm。术中行头皮创面清创后，安装可持续型皮肤牵张器，安装后第3天开始对创面进行牵张，每天牵张1 mm，并均分成3次完成，牵张过程中，注意创缘的血运变化及患者的主观感受，当创面牵张至创缘行创面挤捏闭合式试验阴性时，停止进一步牵张，维持最后的牵张状态3 d后，直接拉拢缝合。观察可持续型皮肤牵张器牵张过程中创面愈合情况及并发症发生情况，测量牵张5、10、15、20 d剩余创面面积。随访观察创面愈合情况及毛发生长情况。 结果： 5例患者创面经牵张治疗19～23 d后直接缝合。牵张过程中创缘无张力性水疱形成，创面缝合后创缘愈合良好，无皮肤坏死发生。牵张治疗5～20 d，创面面积逐渐缩小。术后随访时间2～11(4.5±1.5)个月，牵张处的头皮组织弹性、色泽、感觉与周围正常皮肤组织相似，新生毛发接近正常，创缘可见线性瘢痕，创面无瘢痕形成。 结论： 可持续型皮肤牵张器的应用降低了头皮缺损创面的治疗难度，治疗后新生毛发生长良好，值得临床推广。.
Keywords: Scalp; Skin-stretching device; Soft tissue injuries; Wound healing.