整形技术在修复头面部皮肤软组织缺损中的运用  

Plastic and Aesthetic Surgery for Repairing Craniofacial Soft Tissue Defect

作　　者：杜庆安[1] 张茂红[1] 宗逊[1] 

机构地区：[1]江苏省南京市解放军第八一医院烧伤整形外科,南京210002

出　　处：《中国现代手术学杂志》2008年第5期382-385,共4页Chinese Journal of Modern Operative Surgery

摘　　要：目的总结运用整形技术修复头面部软组织缺损创面的临床经验。方法对86例头面部软组织缺损的患者,采用直接拉拢缝合12例,分次切除后直接拉拢缝合5例,皮肤软组织扩张法术11例,植皮术14例,邻近皮瓣转移加植皮联合修复术6例,邻近皮瓣转移修复术37例,吻合血管的游离大网膜＋游离皮片移植修复1例。结果扩张器外露1例;4例皮瓣远端小部分坏死,创面延期愈合;1例游离移植的大网膜坏死后重新植皮修复;移植的皮片小部分表皮坏死或水疱形成2例,换药后延期愈合,余均一期愈合。植皮成活率为85%-100%。24例随访3个月-10年：2例皮瓣蒂部“猫耳”再次手术矫正;3例植皮周边疤痕增生,经再次手术后平整;3例死亡（肺部转移2例,脑溢血1例）;16例功能、外形均满意,头发生长良好。结论头面部皮肤软组织缺损的修复方法应根据患者的具体情况灵活运用,尽量选用质地相配的组织。Objective To summarize the clinical experiences of plastic and aesthetic techniques for repairing craniofacial soft tissue defect. Methods 86 patients with craniofacial soft tissue defect were retrospectively analyzed. The procedures were as follows： direct suture in 12, direct closure following scar fractional resection in 5, skin soft tissue expansion in 11, skin grafting in 14, random adjacent flap transferring combined with skin grafting in 6, adjacent flap transferring in 37, and free omentum transferring plus free skin grafting in 1 cases. Results One case occurred dilator exposure. Four cases obtained delayed recovery due to minor partial distal flap necrosis. One case received re-grafting of skin after free omentum necrosis. Two cases got delayed recovery by dressing change because of epidermal necrosis in the skin grafts. The survival rate of the skin graft was 85% - 100%. Twenty-four cases were followed up for 3 months to 10 years. The reoperations were performed, including 2 of the ＂ cat ear＂ correcting in pedicle of skin flap, 3 of dressing the hyperplastic cicatrices. Two cases died of lung metastasis and one died of cerebral haemorrhage. The other 16 cases were achieved satisfactory results in both appearance and function. Conclusions The plastic and aesthetic techniques should be selected and applied for repairing the craniofacial soft tissue defects according to the different individual conditions. Furthermore, the similar texture autograft would be chosen as far as possible.

关 键 词：面部损伤 外科皮瓣 软组织损伤 修复外科手术 

分 类 号：R782[医药卫生—口腔医学]