افزايش بيش از حد حجم دهنده هاي بافتي در اسكارهاي صورت

Over Expanded Tissue Expansion for Facial Scars

ﺯﻣﻴﻨﻪ ﻭ ﻫﺪﻑ: ﺍﻓـﺰﺍﻳﺶ ﺣﺠﻢ ﻣﻮﻓﻘﻴﺖ ﺁﻣﻴﺰ ﺑﺎ ﮐﻤﮏ ﻭﺳﻴﻠﻪ ﺍﺗﺴﺎﻉ ﻧﺴﺞ Tissue Expander-(TE)][ ﻭ ﭘﻮﺷﺶ ﺩﺍﺩﻥ ﺻﻮﺭﺕ ﺑﺎ ﺑﺎﻓﺖ ﻣﺸﺎﺑﻪ، ﺍﺯ ﻧﻈﺮ ﺭﻧﮓ ﻭ ﻣﺎﻫﻴﺖ ﺑﺎ ﻣﺤـﺪﻭﺩﻳﺖ ﻫﺎﻳﻲ ﺭﻭﺑﺮﻭ ﺍﺳﺖ ﻛﻪ ﺍﺯ ﺁﻥ ﺟﻤﻠﻪ ﻣﻴـﺰﺍﻥ ﭘﻮﺳﺖ ﺗﻮﻟﻴﺪ ﺷﺪﻩ ﻣﻲ ﺑﺎﺷﺪ. ﺍﻧﺘﺨﺎﺏ ﻭﺳﺎﻳﻞ ﮐﻮﭼﮑﺘﺮ ﻭ ﺍﻓـﺰﺍﻳﺶ ﺣﺠﻢ ﺯﻳﺎﺩﺗﺮ ﺁﻥ، ﻣﻲ ﺗﻮﺍﻧﺪ ﻓﻼﭖ ﻗﺎﺑﻞ ﺍﺳﺘﻔﺎﺩﻩ ﺑﻴﺸﺘـﺮﻱ ﺍﻳﺠﺎﺩ ﻛﺮﺩﻩ ﻭ ﻧﺘﻴﺠﻪ ﺑﻬﺘﺮﻱ ﺭﺍ ﺑﻪ ﺩﻧﺒﺎﻝ ﺩﺍﺷﺘﻪ ﺑﺎﺷﺪ. ﻣﻮﺍﺩ ﻭ ﺭﻭﺵ ﻫﺎ: ﺩﺭ ﺗﺠـﺮﺑﻴﺎﺕ ﻣﺎ 32 ﺑﻴﻤﺎﺭ ﻣﻌﺮﻓﻲ ﻣﻲ ﺷﻮﻧﺪ ﮐﻪ 52 ﺣﺠﻢ ﺩﻫﻨﺪﻩ ﺑﺎﻓﺘﻲ ﺑﺮﺍﻱ ﺁﻧﻬﺎ ﺗﻌﺒﻴﻪ ﺷﺪﻩ ﺍﺳﺖ. ﺍﺯ ﺍﻳﻦ ﺗﻌﺪﺍﺩ 29 ﻣﻮﺭﺩ ﻗﺮﺑﺎﻧﻴﺎﻥ ﺳﻮﺧﺘﮕﻲ ﺳﺮ ﻭ ﮔﺮﺩﻥ، ﻳﮏ ﻣﻮﺭﺩ، ﺧﺎﻝ ﺑﺰﺭﮒ ﻣﻮﺩﺍﺭ ﻭ ﺩﻭ ﻣﻮﺭﺩ ﺑﻴﻤﺎﺭﺍﻧﻲ ﺑﻮﺩﻧﺪ ﮐﻪ ﻋﻤﻞ ﺟﺮﺍﺣﻲ ﺑﺮﺩﺍﺷﺘﻦ ﭘﺴﺘﺎﻥ )ﻣﺎﺳﺘﮑﺘـﻮﻣﻲ( ﺭﻭﻱ ﺁﻧﻬﺎ ﺻﻮﺭﺕ ﮔﺮﻓﺘﻪ ﺍﺳﺖ. TE ﮐﻮﭼﮑﺘﺮ ﺍﺯ ﻣﻌﻤـﻮﻝ ﺑﺎ ﺍﻓﺰﺍﻳﺶ ﺣﺠﻢ ﺯﻳﺎﺩﺗﺮ ﺁﻥ ﺑﻪ ﻣﻴﺰﺍﻥ 2 ﺗﺎ 4 ﺑﺮﺍﺑﺮ ﺣﺠﻢ ﺛﺒﺖ ﺷﺪﻩ، ﺩﺭ ﺗﻤﺎﻣﻲ ﺑﻴﻤﺎﺭﺍﻥ ﺑﻪ ﮐﺎﺭ ﮔﺮﻓﺘﻪ ﺷﺪ. ﻳﺎﻓﺘﻪ ﻫﺎ: ﺑﺎ ﺍﺳﺘﻔـﺎﺩﻩ ﺍﺯ ﺭﻭﺵ ﺑﺎﻻ، ﭘﻮﺳـﺖ ﻗﺎﺑﻞ ﺍﻧﺘﻘﺎﻝ ﺑﻴﺸﺘـﺮﻱ ﺟﻬﺖ ﭘﻮﺷﺎﻧﺪﻥ ﻗﺴﻤـﺖ ﻫﺎﻱ ﻣﻌﻴـﻮﺏ ﺑﻪ ﺩﺳﺖ ﺁﻣـﺪ. ﻣﻴـﺰﺍﻥ ﻋـﻮﺍﺭﺽ ﻣﺎﮊﻭﺭ ﻭ ﻣﻴﻨـﻮﺭ ﺩﺭ ﻣﻘﺎﻳﺴﻪ ﺑﺎ ﻣﻄﺎﻟﻌـﺎﺕ ﻗﺒﻠـﻲ ﺍﺧﺘﻼﻑ ﻗـﺎﺑﻞ ﻣﻼﺣﻈﻪ ﺍﻱ ﺭﺍ ﻧﺸﺎﻥ ﻧﺪﺍﺩ. ﺗﺼـﺎﻭﻳﺮ ﭼﻨﺪ ﻣـﻮﺭﺩ ﺑﻪ ﻋﻨﻮﺍﻥ ﻧﻤـﻮﻧﻪ ﺍﺭﺍﺋﻪ ﺷﺪﻩ ﺍﺳﺖ. ﻧﺘﻴﺠﻪ ﮔﻴـﺮﻱ: ﺗﮑﻨﻴﮏ ﺟﺮﺍﺣﻲ ﺩﻗﻴﻖ، ﺍﻳﺠﺎﺩ ﺑﺮﺵ ﻫﺎﻱ ﻛﻮﭼﻜﺘﺮ ﺑﻪ ﻣﻨﻈﻮﺭ ﺗﻮﻟﻴﺪ ﻓﺸﺎﺭ ﮐﻤﺘﺮ ﺩﺭ ﺳﻄﺢ ﺯﺧﻢ ﺍﺯ ﻋﻮﺍﻣﻞ ﻣﻬﻤﻲ ﺍﺳﺖ ﮐﻪ ﺩﺭ ﮐﺎﻫﺶ ﻣﻴﺰﺍﻥ ﻋﻮﺍﺭﺽ ﻣـﺆﺛﺮ ﺑﻮﺩﻩ ﻭ ﺑﺎﻋﺚ ﺍﻃﻤﻴﻨﺎﻥ ﺍﺯ ﻣـﻮﻓﻘﻴﺖ ﻭ ﺟﻠﻮﮔﻴﺮﻱ ﺍﺯ ﻧﺘﺎﻳﺞ ﻧﺎﺧﻮﺍﺳﺘﻪ ﺧﻮﺍﻫﺪ ﺷﺪ.

Introduction & Objective: Successful inflation of the expander device and coverage of the face with tissue of similar color and texture is usually limited by the amount of skin generated. Selecting a smaller device and over expanding it produces more flap generation and an overall better reconstructive outcome. Materials & Methods: Described are the experiences encountered from 32 patients in whom a total of 52 expanders were inserted; 29 patients were burn victims with head and neck scars, one case was of a giant hairy nevus and two were post mastectomy patients. In all cases, a smaller device was applied with subsequent overexpansion to 2-4 times its registered volume. Results: In using the above technique, we gained more transferable skin which was used to cover the defects. In comparing our results to previous studies, the rate of major and minor complications was the same. Illustrations of several representative cases are submitted. Conclusions: Meticulous surgical techniques using smaller non-tension bearing incisions are important in minimizing complication rates of the procedure, ensuring its success, and allowing for salvage in case of any mishaps.