侧胸部扩张带蒂皮瓣在面颈部大面积缺损修复中的应用  

The Application of Expanded Lateral Thoracic Pedicle Flap in Repairing Large Defect of Face and Neck

作　　者：李华[1] 徐昆明 昝涛[1] 谢芸[1] 刘凯[1] 顾斌[1] 谢峰[1] LI Hua;XU Kunming;ZAN Tao;XIE Yun;LIU Kai;GU Bin;XIE Feng(Department of Plastic and Reconstructive Surgery,Shanghai Ninth People's Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200011,China;Department of Burn and Plastic Surgery,Qingyuan People’s Hospital,Qingyuan 511550,China)

机构地区：[1]上海交通大学医学院附属第九人民医院整复外科,上海市200011 [2]清远市人民医院烧伤整形科,广东省清远市511550

出　　处：《组织工程与重建外科杂志》2019年第3期163-167,共5页Journal of Tissue Engineering and Reconstructive Surgery

基　　金：国家自然科学基金青年项目(81201481)

摘　　要：目的探讨侧胸部皮瓣经扩张后带蒂修复大面积面颈部缺损的可行性。方法本组共10例面颈部烧伤瘢痕患者,手术分两期进行:一期在侧胸部埋入扩张器,注水4~6个月后,二期手术切除面颈部瘢痕,侧胸部扩张皮瓣带蒂转移修复面颈部缺损。两期手术前均可行超声血管定位,皮瓣转位前可行延迟手术。结果本组病例侧胸部皮瓣的供血血管来源于胸外侧动脉、胸背动脉以及副侧胸动脉三者中的一支或两支。术后随访3~15个月,其中9例均获得满意疗效,一例皮瓣远端坏死经植皮修复。供区皆一期闭合。结论侧胸部扩张皮瓣修复面颈部缺损,皮瓣颜色、质地接近,供区损伤小,为头颈部重建提供了另一种选择。Objective To explore the feasibility of the expanded lateral thoracic pedicle flap in repairing the large defect of face and neck.Methods Ten patients with burn scars on face and neck were treated with the expanded lateral thoracic pedicle flap.At the first stage,tissue expander was embedded in the lateral thoracic area.After an interval of 4 to 6 months during which the tissue expander was sufficiently inflated,the scar on head and neck was removed,and the expanded lateral thoracic flap was elevated and transferred to restore the defect of head and neck region in second stage.Ultrasonic examinations were employed before both operations.Before flap transfer,a delay procedure was performed to assure better flap viability.Results This pedicle flap was based either on the lateral thoracic artery,the thoracodorsal artery,or the accessory-lateral thoracic artery and their vena comitans.Nine patients had satisfactory outcomes with 3 to 15 months of follow-up.One patient suffered from partial flap necrosis in the distal part of the flap,and was repaired by skin grafting.All of the donor sites were primarily closed.Conclusion The expanded lateral thoracic pedicle flap can provide another option for head and neck reconstruction with optimal skin color,texture and minimal donor site morbidities.

关 键 词：侧胸部皮瓣 扩张器 带蒂皮瓣 面颈部瘢痕 

分 类 号：R622[医药卫生—整形外科]