扩张的超薄皮瓣分区修复颜面部烧伤瘢痕  

The clinical application of expanded super-thin flap for postburn scars on face

作　　者：张继[1] 王春梅[1] 尹琳[1] 张君毅[1] 马婷婷[1] 范金财[1] 

机构地区：[1]中国医学科学院中国协和医科大学整形外科医院颅颌面外科,北京100041

出　　处：《中国美容医学》2007年第1期47-51,共5页Chinese Journal of Aesthetic Medicine

摘　　要：目的:对于烧伤后大面积面部瘢痕,探讨一种能最大限度达到面部特殊功能和形态要求的组织修复方法。方法:根据瘢痕的范围结合美容分区将扩张器置入真皮下血管网下;术后5天开始注水,间隔3～5天,平均约60天完成注水过程;瘢痕切除,扩张皮瓣分叶或不分叶转移修复缺损,必要时辅以扩张后的真皮下血管网皮片移植,均取得良好的效果。结果:术后随访6个月到2年,38个病例转移后的皮瓣不需要修薄,外观和功能均比较满意。结论:保留真皮下血管网的扩张皮瓣结合扩张后的真皮下血管网皮片移植能够提供较多的高质量的额外皮肤,是一种高效、实用并且更接近颜面部美学标准的组织修复方法。Objective Postburn facial scars are common sequelae that require a surgical procedure. Many methods have been proved effective clinically, but the contour of the face and the shape of the organs were difficult to restore and ischemic complications were often reported by previous authors. The technique of tissue expansion was applied in divisional reconstruction of facial defects that could not be primarily closed in our department during these years to search for a practical and aesthetic approach. Methods 38 patients were divided into three types according to the range of scarring. Type one included lesions within one aesthetic unit. Type two included lesions covering one or more aesthetic units. Type three were extensive scarring, multi-staged procedures were carried out in all types. In stage Ⅰ the expanders were inserted in the subcutaneous pockets and subdermal vascular plexus were preserved. After the flaps were expanded, scars were removed and the covering flaps were Iobulated or not and transferred into place with the addition of expanded full-thickness skin grafts if necessary in stage Ⅱ. For extensive scarring, more surgical procedures needed to be performed. Results A distal superficial necrosis measured 3cm×2cm of expanded flap after transferring and a small part of the expanded flap necrosis at the end stage of expansion because of the compression between two expanded flaps were observed separately in two cases. There were no other complications. No debulking procedures were necessary. Postoperative follow up for 6 months to 2 years showed satisfactory results with good appearance and function. Conclusion We have been favorably impressed with the use of expanded skin flap for facial reconstruction, which has the advantages of creating a large amount of thin tissue of both good color and texture, and high viability, without the disadvantages of donor-site morbidity, and bulky appearance of flap, In our opinion, this is a good choice for facial reconstruction that can minimize contractures and def

关 键 词：烧伤瘢痕 组织扩张 超薄皮瓣 分区修复 

分 类 号：R619.6[医药卫生—外科学]