预扩张额部轴型皮瓣修复面颈部大面积良性病变切除后创面  

Application of pre-expanded pedicled forehead flap in the repair of wound after resection of faciocervical large area benign lesions

作　　者：陈红波 田佳 李峰永 范金财 刘立强 甘承 杨增杰 焦虎 张倜然 张桦 刘征 曾妍 苏治国 CHEN Hong-bo;TIAN Jia;LI Feng-yong;FAN Jin-cai;LIU Li-qiang;GAN Cheng;YANG Zeng-jie;JIAO Hu;ZHANG Ti-ran;ZHANG Hua;LIU Zheng;ZENG Yan;SU Zhi-guo(The Ninth Department of Plastic Surgery,Plastic Surgery Hospital of Peking Union Medical College of Chinese Academy of Medical Sciences,Beijing 100144,China)

机构地区：[1]中国医学科学院北京协和医学院整形外科医院整形九科,北京100144 [2]中国医学科学院北京协和医学院整形外科医院整形十科,北京100144

出　　处：《中国美容整形外科杂志》2019年第11期658-661,共4页Chinese Journal of Aesthetic and Plastic Surgery

摘　　要：目的探讨预扩张额部轴型皮瓣在面颈部大面积良性病变切除后创面的临床应用及其美学修复效果。方法自2013年6月至2018年4月,对收治的43例面颈部大面积良性病变患者,采用预扩张额部轴型皮瓣进行修复。其中面颈部巨痣者38例,血管瘤者4例,反常性痤疮者1例。病变面积为7cm×6cm^30cm×13cm。一期手术于额肌深面埋置1枚200~400ml长方形扩张器,常速注水扩张3~6个月;二期手术在切除面颈部病变组织后,以额部轴型扩张皮瓣修复缺损创面。根据病变部位、面积及形状,选择双侧颞浅动脉为蒂、单侧颞浅动脉为蒂或单侧滑车上动脉为蒂;三期手术在二期手术后3周进行皮瓣断蒂及修整。结果部分患者以单侧颞浅动脉为蒂的额部皮瓣于二期术后出现远端淤紫、肿胀等轻微并发症,经对症处理,未影响手术效果;其余患者手术顺利,无严重并发症发生。供瓣区可直接拉拢缝合,瘢痕不明显。受区转移皮瓣全部成活,且形态较自然、美观。结论采用预扩张额部轴型皮瓣修复大面积面颈部良性病变切除后创面,其疗效可靠,美学效果良好。Objective To explore the clinical application and aesthetic effect of pre-expanded pedicled forehead flap in the repair of wound after resection of faciocervical large area benign lesions.Methods From June 2013 to April 2018,pre-expanded pedicled forehead flap was applied in 43 patients suffering from faciocervical large area benign lesions.The patients were consisted of 38 giant congenital nevus,4 hemangioma and 1 acne inverse.The lesion area ranged from 7 cm×6 cm to 30 cm×13 cm.In the one-stage operation,a rectangular tissue expander of 200 ml to 400 ml was inserted into a submuscular pocket on patients′forehead and inflated with normal saline for 3 to 6 months.In the two-stage operation,the pre-expanded pedicled forehead flap was designed to repair the defect wound after excision the faciocervical lesions.The flap could be supplied by the bilateral superficial temporal artery,unilateral superficial temporal artery or unilateral supratrochlear artery according to the region,area and shape of the lesion.In the three-stage operation,the flap was pedicle division and restored at 3 weeks after the two-stage operation.Results A fewof minor complications such as distal siltation and swelling happened in patients who utilize unilateral superficial temporal artery as pedicle during the two-stage operation.After symptomatic treatment,the surgical efficacy was not affected.The rest patients had smooth operations and no severe complications occurred.The donor sites were closed directly and the scars were not obvious.The flaps in recipient site were survived and the function and appearance were nature and beautiful.Conclusion The application of pre-expanded pedicled forehead flap in the repair of faciocervical large area benign lesions had reliable efficacy,and the aesthetic effect was good.

关 键 词：额部皮瓣 轴型皮瓣 预扩张技术 体表良性病变 

分 类 号：R73[医药卫生—肿瘤]