摘要
目的探讨4类预扩张皮瓣在面颈部不同亚单位病损修复中的方案及策略。方法2014年1月至2019年6月,西京医院整形外科采用4类预扩张皮瓣修复面颈部病损493例,男207例,女286例,年龄5~42岁;面颈部瘢痕406例,色素病变87例。病损面积1 cm×1 cm^22 cm×18 cm。将面颈部划分为:面中区、面颊区、颈区、颏区、额区、颞区、眼周区、口周区共8个区域,根据面颈部亚单位病损区域特点,选择周围可扩张皮瓣:Ⅰ类扩张额部正中皮瓣修复面中区病损;Ⅱ类扩张胸三角皮瓣修复睑裂水平以下面颊及口周区、颏颈区病损;Ⅲ类扩张颈横动脉颈段皮支皮瓣修复颈区及颏区病损;Ⅳ类头部扩张皮瓣修复额区及颞区病损,转移皮瓣的多余毛发行激光脱毛治疗。对于跨亚单位的大面积病损,多个扩张皮瓣联合应用,观察各类预扩张皮瓣的修复效果。结果本组共493例,埋置扩张器共572个,486例有效扩张患者顺利完成扩张皮瓣对面部亚单位病损切除后的修复与重建,其余7例因扩张器感染及外露致扩张失败。486例中Ⅰ类皮瓣43例;Ⅱ类皮瓣238例;Ⅲ类皮瓣61例;Ⅳ类皮瓣107例;Ⅰ+Ⅱ类组合皮瓣6例;Ⅱ+Ⅳ类组合皮瓣31例。扩张皮瓣面积1 cm×1 cm^27 cm×18 cm,单一皮瓣中以胸三角扩张皮瓣修复面积最大,约22 cm×12 cm;组合皮瓣以Ⅱ和Ⅳ类扩张皮瓣修复面部、颞部病损范围更大,最大约为27 cm×18 cm。术后8例皮瓣远端出现血运障碍,经加压包扎及换药处理逐渐愈合,无明显瘢痕增生。所有扩张皮瓣修复面颈部外观及功能明显改善。术后随访6个月至4年,皮瓣颜色、厚度、质地均与原部位相近,瘢痕不明显,但转移至颈部的皮瓣边缘因活动及牵拉,有42例患者头部后仰时出现瘢痕挛缩带,平视时消失。结论对于面颈部亚单位的病损,可采用面部及周围4类预扩张皮瓣的灵活应用及组合使用,可提供超大面积的薄层皮瓣,不仅血运好
Objective To explore the scheme and strategy of four kinds of pre-expanded skin flaps used for reconstruction of the face and neck subunit lesions.Methods From January 2014 to June 2019,493 cases of facial and neck lesions were repaired with four types of pre-expanded flaps in Plastic Surgery Department of Xijing Hospital.There were 207 males and 286 females aged from 5 to 42 years,406 face and neck scars and 87 pigment lesions.The lesion area ranged from 1 cm×1 cm to 22 cm×18 cm.The face and neck were divided into 8 regions:middle facial region,cheek region,neck region,chin region,frontal region,temporal region,periorbital region and perioral region.According to the regional characteristics of the facial and neck subunits,the expandable skin flaps were selected:typeⅠexpanded forehead midline flap to repair the lesions in middle facial region;and type II expanded thoracic deltoid flap was used to repair the lesions in the cheek,perioral region and chin neck region below the level of eye;type III expanded neck transverse flap was used to repair the lesions in the neck region and chin region;type IV expanded head flap was used to repair the lesions in the frontal region and temporal region,the excess hair of the transferred skin flap were removed by laser.For large cross-subunit lesions,multiple expanded flaps were used in combination to observe the effect of different types of pre-expanded flaps.Results There were 493 patients with 572 implanted expanders,486 patients with effective dilatation successfully completed the repair and reconstruction of the facial subunits.The other 7 patients failed due to dilatation due to dilator infection and exposure.There were 43 forehead expanded flaps type I,238 thoracic deltoid expanded flaps type II,61 neck transverse expanded flaps type III,107 head expanded flaps type IV,6 I+II combined flaps and 31 II+IV combined flaps.The area of expanded flaps ranged from 1 cm×1 cm to 27 cm×18 cm.Among the single flaps,the thoracic deltoid expanded flap had the largest repair area,
作者
唐银科
楚菲菲
马显杰
Tang Yinke;Chu Feifei;Ma Xianjie(Department of Plastic and Reconstructive Surgery,First Affiliated Hospital of Air Force Medical University(Xijing Hospital),Xi’an 710032,China)
出处
《中华整形外科杂志》
CSCD
北大核心
2020年第10期1088-1094,共7页
Chinese Journal of Plastic Surgery
基金
国家自然科学基金(81671925)
陕西省重点研发计划项目(2018ZDXM-SF-081)。
关键词
组织扩张
外科皮瓣
修复重建
面部
瘢痕
Tissue expansion
Surgical flaps
Reconstruction
Facial
Cicatrix
