分区预扩张颈浅动脉蒂颈肩背皮瓣修复面部大面积缺损  

Large facial defect reconstruction with partition pre-expanded cervico.scapulo-dorsal flaps based on the superficial cervical artery

作　　者：姜平[1] 陈其庆[1] 胡振富[1] 罗勇[1] 胡志奇[1] 高建华[1] 

机构地区：[1]南方医科大学南方医院整形美容外科,广州510515

出　　处：《中华整形外科杂志》2016年第1期39-42,共4页Chinese Journal of Plastic Surgery

基　　金：上海市市级医院新兴前沿技术联合攻关项目（SHDC12010105-07）;国家临床重点专科建设项目（2013-544）

摘　　要：目的探讨应用分区预扩张颈浅动脉蒂颈肩背皮瓣转移修复面部大面积皮肤组织缺损的临床效果。方法手术分3期。一期根据面部缺损面积沿颈浅动脉蒂轴线设计皮瓣，采用分区法置入扩张器，即于皮瓣轴线旁侧、皮瓣后侧半区域埋置扩张器，即仅对皮瓣1／2面积予以扩张。二期向扩张器内定期注水、连续扩张。三期切取预扩张颈浅动脉蒂颈肩背皮瓣，转移修复面部缺损，所转移皮瓣包含未扩张部分约1／2面积。结果2008年11月至2013年12月，共修复面部大面积增生性瘢痕或瘢痕挛缩畸形患者15例，扩张周期3—4个月，扩张容量680—960ml。1例皮瓣远端4．0cm×1．5cm范围表皮坏死、瘢痕愈合，1例皮瓣远端出现水泡，水泡脱落后未遗留瘢痕，其余13例皮瓣完全成活。术后随访12～38个月，平均26．2个月，面部外形恢复良好，供区瘢痕增生不明显。结论应用预扩张颈浅动脉蒂颈肩背皮瓣修复大面积面部皮肤组织缺损，可获得良好的修复效果；采用分区预扩张使转移皮瓣包含部分未扩张皮肤，可预防静脉回流障碍，提高皮瓣成活率。Objective To assess the outcome of large facial defect reconstruction with ＂partition＂ pre-expanded cervico-scapulo-dorsal flaps （CSDF） based on the superficial cervical artery （SCA）. Methods Surgical course consisted of 3 stages. In stage Ⅰ , a skin flap was designed along the axis of SCA according to the facial defect and an expander was implanted in the cervico-scapulo-dorsal region by means of ＂partition＂ expansion. The expanders were implanted beside the flap axis and beneath the posterior half of flaps so as to expand only half area of the flap. During the stage Ⅱ , expanders were injected with saline regularly for continuous expansion. In stage Ⅲ, the pre-expanded CSDFs were transferred to cover the facial defect of which the CSDFs included about half of non-expanded area. Results From November of 2008 to December of 2013, 15 patients with facial hypertrophic scar or scar contracture were reconstructed with pre-expanded CSDF based on the SCA. The expansion lasted for 3 to 4 months, and the expanded volume varied from 680 to 960 ml. One case of 4. 0 cm × 1.5 cm epidermal/lap necrosis occurred and healed subsequently with superficial sear ; and another case of blister formation in the distal part of flap was found, which recovered without scar; the other 13 flaps survived without complications. After a follow-up for 12 to 38 months（ average 26.2 mouths） , patients regained satisfactory appearance of face, with no obvious hypertrophic scar in the donor site. Conclusions Partition pre-expanded CSDF based on the SCA is a good choice for large facial defect reconstruction, and the partition expansion is an effective strategy for prevention of venous congestion.

关 键 词：面部损伤 软组织扩张术 颈浅动脉 外科皮瓣 

分 类 号：R622[医药卫生—整形外科]