额部滑车上动脉岛状预扩张皮瓣治疗儿童面中部鼻旁巨痣  

The island pre-expanded supratrochlear artery flap in the treatment of midfacial giant nevus in children

作　　者：王维东 沈卫民[1] 崔杰[1] 陈建兵[1] 熊佳更 Wang Weidong;Shen Weimin;Cui Jie;Chen Jianbing;Xiong Jiageng(Department of Burns and Plastic Surgery,Children’s Hospital of Nanjing Medical University,Nanjing 210008,China)

机构地区：[1]南京医科大学附属儿童医院烧伤整形科,南京210008

出　　处：《中华整形外科杂志》2022年第11期1249-1253,共5页Chinese Journal of Plastic Surgery

摘　　要：目的探讨应用额部滑车上动脉岛状预扩张皮瓣治疗儿童先天性面中部鼻旁巨痣的可行性及效果。方法回顾性分析2019年1月至2021年1月, 南京医科大学附属儿童医院烧伤整形科收治的儿童先天性面中部鼻旁巨痣患儿的临床资料。患儿均采用额部滑车上动脉岛状预扩张皮瓣修复, 治疗分2期或3期, 一期手术, 根据病变大小, 确定扩张器容量, 于额部额肌下埋置100~400 ml肾形扩张器, 定期注水扩张, 扩张频率1~2次/周。二期手术, 取出扩张器, 切除面部巨痣, 根据黑痣的大小、形状设计岛状皮瓣, 完全修复面部缺损。三期手术对转移的皮瓣进行修整。术后随访观察并发症发生情况、皮瓣转移后血运情况及治疗效果。结果本组共纳入10例患儿, 男6例, 女4例, 年龄4~12岁, 平均7.8岁。其中4例行二期手术, 6例行三期手术。一期术后扩张时间10~12周, 平均11.4周, 在扩张过程中均未发生渗漏、外露、扩张器成角及扩张皮瓣血运障碍等并发症。二期手术中切取的扩张皮瓣面积7 cm×6 cm ~12 cm ×10 cm, 术后2 d有2例皮瓣的远端出现了静脉回流障碍, 予针刺放血及拆除部分缝线等处理后皮瓣血运恢复, 未发生明显皮瓣坏死, 其余皮瓣均存活良好。经过二期和三期手术完成治疗的患儿, 术后随访3个月至1年, 黑痣均无复发, 所有的扩张皮瓣颜色、质地与面部正常皮肤接近, 且未发现皮瓣有明显挛缩, 额部供区瘢痕亦不明显。结论应用额部滑车上动脉岛状预扩张皮瓣治疗儿童面中部鼻旁巨痣, 效果可靠, 并发症少, 可避免面中部瘢痕形成及继发畸形的产生。Objective To investigate the feasibility and effect of applying the island pre-expanded supratrochlear artery flap to treat mid-facial giant nevus near the nose in children.Methods From January 2019 to January 2021,10 cases of midfacial giant nevus patients were treated with the island pre-expanded supratrochlear artery flap in the Department of Burn and Plastic Surgery of Children’s Hospital of Nanjing Medical University.The process of treatment was divided into three stages.Stage 1:The expander capacity was determined according to the lesion size.The expander was implanted under the frontal muscle,and the flap was regularly expanded postoperatively.Stage 2:The expander was removed,and the lesion was excised.The expanded flap was designed according to the shape and size of the lesion.Stage 3:The transferred flap was trimmed.The postoperative complications and the blood supply after flap transfer were observed.The treatment effect was evaluated during the follow-up after the operation.Results A total of 10 children were included in this group,including six males and four females,aged 4-12 years,with an average age of 7.8 years.Six patients underwent three-stage surgery,and four patients underwent two-stage surgery.During the first stage,a 100-400 ml renal expander was implanted,and tissue expansion was conducted once or twice a week.The expansion lasted 10 to 12 weeks(average,11.4 weeks).Complications such as leakage,angle,and blood supply obstruction were not observed during the expansion process.The size of the expanded frontal flap was 7 cm×6 cm~12 cm×10cm.Venous congestion occurred at the distal end of the flap in 2 cases,which was treated by partial suture removal and acupuncture bleeding treatment.No flap necrosis occurred.The donor sites were closed directly.No recurrence was observed during the 3-month to 1-year follow-up period.All expanded flaps had no obvious contraction with a good match of color and texture.Conclusions The island pre-expanded supratrochlear artery flap provides an ideal selection

关 键 词：外科皮瓣 滑车上动脉 面部 儿童 软组织扩张器 巨痣 

分 类 号：R758.51[医药卫生—皮肤病学与性病学]