摘要
目的总结扩张的胸廓内动脉穿支(IMAP)皮瓣联合血管增压在面颈部瘢痕整复中的临床应用经验。方法采用回顾性观察性研究方法。2012年9月—2021年5月,上海交通大学医学院附属第九人民医院收治23例符合入选标准的烧创伤后面颈部瘢痕患者,其中男18例、女5例,年龄11~58岁,均采用扩张的IMAP皮瓣整复。Ⅰ期根据瘢痕部位和范围在前胸置入1个或2个合适额定容量的皮肤软组织扩张器,术中注意保护IMAP、锁骨上动脉胸支和胸外侧动脉,术后注入生理盐水进行扩张。Ⅱ期行皮瓣转移术,术前使用彩色多普勒超声血流探测仪明确优势IMAP。切除面颈部瘢痕,形成面积为9 cm×7 cm~28 cm×12 cm的创面,术中注意保留颞浅动静脉或面动静脉穿支。以优势IMAP为蒂,根据瘢痕切除后创面面积和位置设计皮瓣:对于中小面积的创面,采用IMAP单蒂皮瓣转移修复;对于缺损面积较大者,利用吲哚菁绿血管造影(ICGA)评价前胸各血管的供血范围,当IMAP不足以供养整块皮瓣时,利用锁骨上动脉胸支或胸外侧动脉进行血管增压,设计双蒂皮瓣。根据供受区间的距离,选择带蒂或游离转移皮瓣。转移皮瓣后再次行ICGA判断皮瓣血供。将供瓣区直接拉拢缝合。统计皮肤软组织扩张器置入个数、额定容量、注射生理盐水量和扩张周期,优势IMAP位置,采用皮瓣总个数和不同血管蒂类型皮瓣个数、皮瓣面积,Ⅱ期术后皮瓣存活情况、供受区常见并发症发生情况和随访情况。结果共置入25个皮肤软组织扩张器,皮肤软组织扩张器额定容量为200~500 mL,注射生理盐水量855~2055 mL,扩张周期4~16个月。术前在第2肋间(20侧)或第3肋间(5侧)探及优势IMAP。共切取25个扩张皮瓣,其中2个IMAP带蒂皮瓣、11个IMAP游离皮瓣、4个锁骨上动脉胸支带蒂+IMAP游离皮瓣、8个IMAP+胸外侧动脉游离皮瓣,皮瓣面积10 cm×8 cm~30 cm×14 cm。Ⅱ期术后3例患者出�
Objective To summarize the clinical experience of expanded internal mammary artery perforator(IMAP)flap combined with vascular supercharge in reconstruction of faciocervical scar.Methods The retrospective observational study was conducted.From September 2012 to May 2021,23 patients with postburn or posttraumatic faciocervical scars who met the inclusion criteria were admitted to Shanghai Ninth People's Hospital of Shanghai Jiao Tong University School of Medicine,including 18 males and 5 females,aged from 11 to 58 years,all of whom were reconstructed with expanded IMAP flaps.At the first stage,one or two skin and soft tissue expander(s)with appropriate rated capacity were implanted in the anterior chest area according to the location and size of the scars.The IMAP,thoracic branch of supraclavicular artery,and lateral thoracic artery were preserved during the operation.The skin and soft tissue expanders were inflated with normal saline after the operation.The flaps were transferred during the second stage.The dominant IMAP was determined preoperatively using color Doppler ultrasound(CDU)blood flow detector.The faciocervical scars were removed,forming wounds with areas of 9 cm×7 cm-28 cm×12 cm,and the perforators of superficial temporal artery and vein or facial artery and vein were preserved during the operation.The flaps were designed according to the area and size of the wounds after scar resection with the dominant IMAP as the pedicle.Single-pedicle IMAP flaps were used to repair small and medium-sized wounds.For larger defects,the blood perfusion areas of vessels in the anterior chest were evaluated by indocyanine green angiography(ICGA).In situations where the IMAP was insufficient to nourish the entire flap,double-pedicle flaps were designed by using the thoracic branch of supraclavicular artery or lateral thoracic artery for supercharging.Pedicled or free flap transfer was selected according to the distance between the donor areas and recipient areas.After transplantation of flaps,ICGA was conducted again
作者
刘云菡
黄昕
李海洲
高雅姗
顾舒晨
邝依敏
骆申英
张泽伟
顾斌
昝涛
Liu Yunhan;Huang Xin;Li Haizhou;Gao Yashan;Gu Shuchen;Yimin Khoong;Luo Shenying;Zhang Zewei;Gu Bin;Zan Tao(Department of Plastic and Reconstructive Surgery,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China;Department of Plastic and Reconstructive Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《中华烧伤与创面修复杂志》
CAS
CSCD
北大核心
2022年第4期313-320,共8页
Chinese Journal of Burns And Wounds
基金
国家自然科学基金面上项目(81772086,82072177)
上海市“医苑新星”杰出青年医学人才培养资助计划
上海市临床重点专科整形外科项目(shslczdzk00901)
上海交通大学医学院“双百人”计划。
关键词
外科皮瓣
面部
颈
瘢痕
穿支皮瓣
胸廓内动脉
皮肤软组织扩张术
血管增压
Surgical flaps
Face
Neck
Cicatrix
Perforator flap
Internal mammary artery
Skin and soft tissue expansion
Vascular supercharge
