扩张后胸三角皮瓣修复儿童面颈部病损  

Repair of facial and cervical lesions using pre-expanded deltopectoral skin flap in children

作　　者：楚菲菲 唐银科 刘超华 张仔昂 杜靖 熊绍恒 马显杰 Chu Feifei;Tang Yinke;Liu Chaohua;Zhang Ziang;Du Jing;Xiong Shaoheng;Ma Xianjie(Department of Plastic&Reconstruction Surgery,First Affiliated Hospital of Air Force Medical University(Xijing Hospital),Xi'an 710032,China)

机构地区：[1]空军军医大学第一附属医院(西京医院)整形外科,西安710032

出　　处：《中华小儿外科杂志》2022年第4期294-298,共5页Chinese Journal of Pediatric Surgery

基　　金：国家自然科学基金(81671925)。

摘　　要：目的探讨应用扩张后胸三角皮瓣修复儿童面颈部病损的临床效果。方法收集空军军医大学第一附属医院整形外科于2007年1月至2020年7月收治的89例面颈部病损患儿的相关资料。其中,男56例,女33例;年龄分布为5~6岁4例,7~14岁40例,15~18岁45例。所有患儿中,热力烧伤80例,化学烧伤1例,植皮术后效果不佳2例,创面感染2例,血管瘤治疗(放疗+手术)后的瘢痕2例,面部巨痣1例,皮脂腺痣1例。患儿病程为0.5~17.0年。所有患儿均采用扩张胸三角皮瓣带蒂转移修复的手术方法。结果所有患儿手术均顺利完成,共埋置113个皮肤软组织扩张器。一期术后16例出现并发症,共20个扩张器。最常见的并发症为感染,共10例(包括4例双侧埋置扩张器患儿),14个扩张器,仅1例埋置双侧扩张器后发生抗甲氧西林金黄色葡萄球菌(methicillin resistant Staphylococcus aureus,MRSA)感染将扩张器取出终止手术治疗,余9例的感染均得到良好的控制并满足进行二期手术的条件。其余的并发症包括:4例扩张器外露、1例血肿、1例切口裂开。除1例终止手术治疗的患儿外,余88例患儿共111个经扩张器扩张后的胸三角皮瓣均顺利进行二期手术,转移的皮瓣颜色、质地与相邻部位正常皮肤匹配良好,无挛缩及色素沉着发生,治疗效果满意。结论扩张胸三角皮瓣带蒂转移修复术是治疗儿童面颈部病损的一种较好方法。Objective To explore the application of pre-expanded deltopectoral skin flap in the treatment of facial and cervical lesions in children and the prevention of operative complications.Methods From January 2007 to July 2020,clinical data were reviewed for 89 children with faciocervical lesions.There were 56 boys and 33 girls.Age distribution was 5 to 6(n=4),7 to 14(n=40)and 15 to 18 years(n=45).There were thermal burn(n=80),chemical burn(n=1),poor healing after skin grafting(n=2),wound infection(n=2),scar after hemangioma radiotherapy plus surgery(n=2),facial giant nevus(n=1)and sebaceous nevus(n=1).The disease duration ranged from 0.5 to 17.0 years.Pedicled transfer repair was performed with an expanded deltopectoral flap.Results All operations were successfully performed and a total of 113 skin and soft tissue expanders implanted.Complications occurred in 16 children after the first stage with a total of 20 expander.The most common complication was infection.And 14 expander were applied for 10 cases(including 4 expander cases).There was only 1 case of MRSA infection after expander implanting.The expander was removed for terminating surgery.The remaining 9 cases of infection were well controlled and fulfilled the criteria for two-stage surgery.The remaining complications included expander exposure(n=4),hematoma(n=1)and incision dehiscence(n=1).Except for one child terminating surgery,a total of 111 deltopectoral flaps with expanders in remaining 88 children underwent successful two-stage operations.Without contracture or pigmentation,color and texture of transferred flap matched well with normal skin of adjacent sites.Therapeutic efficacy was excellent.Conclusions Pedicled transfer repair with expanded deltopectoral flap is efficacious for faciocervical lesions in children.

关 键 词：瘢痕 扩张术 胸三角皮瓣 儿童 

分 类 号：R726.2[医药卫生—儿科]