以胸廓内动脉穿支为蒂的预扩张胸三角皮瓣游离移植整复面部瘢痕的临床效果  

Clinical effects of free pre-expanded internal thoracic artery perforator pedicled deltopectoral flap transfer in facial scar reconstruction

作　　者：何林 朱婵 贾晶 周林[1] 张卓 舒茂国[1] He Lin;Zhu Chan;Jia Jing;Zhou Lin;Zhang Zhuo;Shu Maoguo(Department of Plastic,Aesthetic&Maxillofacial Surgery,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China;Department of Burns and Cutaneous Surgery,Burn Center of PLA,the First Affiliated Hospital,Air Force Medical University,Xi'an 710032,China)

机构地区：[1]西安交通大学第一附属医院整形美容颌面外科,西安710061 [2]空军军医大学第一附属医院全军烧伤中心,烧伤与皮肤外科,西安710032

出　　处：《中华烧伤与创面修复杂志》2023年第3期241-247,共7页Chinese Journal of Burns And Wounds

基　　金：陕西省重点研发计划(2023-YBSF-179);西安交通大学第一附属医院新医疗新技术(XJYFY-2020W13)。

摘　　要：目的探讨通过彩色多普勒超声行术前血管评估,选取合适的胸廓内动脉穿支并以其为蒂,行预扩张胸三角皮瓣游离移植整复面部瘢痕的临床效果。方法采用回顾性观察性研究方法。2017年9月—2021年3月,西安交通大学第一附属医院收治11例符合入选标准的面部瘢痕患者,其中男6例、女5例,年龄16~58(31±12)岁,瘢痕面积7 cm×5 cm~14 cm×9 cm,均采用以胸廓内动脉穿支为蒂的预扩张胸三角皮瓣游离移植整复。手术分2期或3期进行,术前用彩色多普勒超声对胸廓内动脉血管穿支进行评估。Ⅰ期行皮肤软组织扩张器(以下简称扩张器)置入术,于胸壁置入1个额定容量为400~600 mL的圆柱形扩张器,扩张3~4个月,注水量为扩张器额定容量的1.2~1.5倍。Ⅱ期行瘢痕切除+预扩张胸三角皮瓣游离移植术,皮瓣切取面积为9 cm×7 cm~16 cm×10 cm。将皮瓣血管蒂(胸廓内动脉肋间穿支血管)与面动静脉或者颞浅动静脉进行端端吻合,供区创面直接缝合。5例患者因皮瓣蒂部臃肿在Ⅱ期术后3~6个月行Ⅲ期皮瓣修薄术。在末次手术后6个月统计皮瓣存活、并发症发生情况,并采用塞姆斯温斯坦单丝测验评价皮瓣感觉,将皮瓣与周围正常皮肤颜色进行对比来评价色泽,采用利克特5级量表评价患者的疗效满意度。结果末次手术后6个月,11例患者皮瓣全部存活良好。1例患者皮瓣移植术后出现静脉危象,行二次血管吻合后皮瓣成活;1例患者在Ⅰ期扩张器置入术后出现血肿,清除后未影响后续治疗;所有患者均无感染、扩张器外露等并发症发生。末次手术后6个月,患者皮瓣感觉:9例达到保护性感觉减弱及以上,1例保护性感觉缺失,1例仅存在深部触压觉;患者皮瓣色泽:3例与周围正常皮肤颜色非常接近,6例与周围正常皮肤颜色接近,2例与周围正常皮肤颜色有差异;患者的疗效满意度:2例非常满意,6例满意,2例一般满意,1例有点�Objective To explore the clinical effects of free pre-expanded deltopectoral flap transfer in facial scar reconstruction by selecting appropriate internal thoracic artery perforator as the pedicle through preoperative color Doppler ultrasonic vascular assessment.Methods A retrospective observational study was conducted.From September 2017 to March 2021,11 patients with facial scar who met the inclusion criteria were admitted to the First Affiliated Hospital of Xi'an Jiaotong University,including 6 males and 5 females,aged 16-58(31±12)years.The scar with area ranging from 7 cm×5 cm to 14 cm×9 cm was reconstructed by free pre-expanded internal thoracic artery perforator pedicled deltopectoral flap transfer.The operation was performed in 2 or 3 stages.Before operation,color Doppler ultrasonography was performed to evaluate the internal thoracic artery perforator.In the first stage,skin and soft tissue expander(hereinafter referred to as expander)implantation was performed,and a cylindrical expander with rated capacity of 400 to 600 mL was placed in the chest wall.The expansion time was 3 to 4 months,and the water injection volume reached 1.2-1.5 times of the rated capacity of expander.In the second stage,scar excision+free pre-expanded deltopectoral flap transfer was performed,with harvested flap area ranging from 9 cm×7 cm to 16 cm×10 cm.The vascular pedicle of flap(intercostal perforator of internal thoracic artery)was anastomosed end-to-end to the facial artery and vein or superficial temporal artery and vein.The wound in donor site was closed directly.Third stage operation thinning was performed at 3-6 months after the second stage operation in 5 patients because of bloated flap pedicle.At 6 months after the last operation,the flap survival and complications were recorded,the sensation of flap was evaluated by Semmes-Weinstein monofilament test,the color of flap was evaluated by color contrast of the flap to surrounding normal skin,and the curative effect satisfaction degree of patients was evaluated by 5-g

关 键 词：瘢痕 面部 穿支皮瓣 超声检查 多普勒 彩色 显微外科手术 皮肤扩张术 胸廓内动脉 

分 类 号：R619+.6[医药卫生—外科学] R616.2[医药卫生—临床医学] R622+.1