应用皮瓣连续转移技术修复大面积面颈部瘢痕  

Application of sequential flap transfer technique for the reconstruction of extensive faciocervical scar

作　　者：陈子翔 刘元波 汪淼 朱珊 陈博 李杉珊 韩婷璐 臧梦青 Chen Zixiang;Liu Yuanbo;Wang Miao;Zhu Shan;Chen Bo;Li Shanshan;Han Tinglu;Zang Mengqing(Scar Comprehensive Treatment Center,Plastic Surgery Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,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瘢痕综合治疗中心,北京100144

出　　处：《中华整形外科杂志》2023年第5期472-478,共7页Chinese Journal of Plastic Surgery

基　　金：中国医学科学院整形外科医院院所基金(YS202017)。

摘　　要：目的探讨皮瓣连续转移技术在大面积面颈部瘢痕修复重建中的应用效果。方法回顾性分析2010年6月至2022年4月中国医学科学院整形外科医院瘢痕综合治疗中心收治的面颈部大面积瘢痕患者的临床资料。采用预扩张的上臂内侧皮瓣或锁骨上动脉穿支加皮瓣作为第1皮瓣修复面颈部瘢痕切除后遗留的缺损;于同侧背部切取背阔肌肌皮瓣或胸背动脉穿支皮瓣作为第2皮瓣修复第1皮瓣供区;背部供区直接拉拢缝合。术后对皮瓣成活情况、供受区形态及瘢痕情况进行随访。结果共纳入13例患者,男8例,女5例;年龄5~36岁,中位年龄14岁。13例中有12例为烧伤后瘢痕,其中面部瘢痕5例,颈部瘢痕1例,面颈部瘢痕6例;面部血管瘤放射治疗后瘢痕1例。瘢痕切除、松解后缺损范围为12.0 cm × 8.0 cm~24.5 cm × 8.0 cm。所有患者手术均顺利完成,其中3例患者第1皮瓣为预扩张锁骨上动脉穿支加皮瓣,10例为预扩张上臂内侧皮瓣,皮瓣面积为23.0 cm × 7.0 cm~27.0 cm × 14.0 cm;5例患者第2皮瓣为背阔肌肌皮瓣,8例为胸背动脉穿支皮瓣,皮瓣面积为18.0 cm×7.0 cm~25.0 cm×10.0 cm。术后有1例患者上臂内侧皮瓣断蒂后2 d出现血肿,清除血肿后未影响皮瓣成活,其余皮瓣均顺利成活,切口均一期愈合。13例患者术后随访1~48个月,中位时间为13个月,第1皮瓣颜色、质地及厚度与受区相近,供区无外观畸形;患者对面颈部受区形态、第1皮瓣供区形态及第2皮瓣供区瘢痕情况均表示满意。结论皮瓣连续转移技术可以增强上臂内侧和锁骨上动脉穿支加皮瓣的修复能力,并可以辅助供区直接闭合,从整体上提高了大面积面颈部瘢痕的修复效果。Objective To investigate the effectiveness of sequential flap transfer technique in the reconstruction of extensive faciocervical scar.Methods The clinical data of patients with extensive faciocervical scar admitted to the Scar Comprehensive Treatment Center of Plastic Surgery Hospital of Chinese Academy of Medical Sciences from June 2010 to April 2022 were retrospectively analyzed.Pre-expanded medial arm flap or supraclavicular artery perforator plus flap were harvested and used as the first flap to repair the defects left by faciocervical scar resection.Latissimus dorsi myocutaneous flaps or thoracodorsal artery perforator flaps were harvested from the ipsilateral back and used as the second flap to repair the donor sites of the first flap.Donor sites at the back were directly sutured.The survival of flaps,the morphology of donor sites and recipient sites and the scar of donor site were followed up.Results A total of 13 patients,aged from 5 to 36 years(median age,14 years),were included,including 8 males and 5 females.Twelve of the 13 cases were post-burn scar,including facial scars in 5 cases,cervical scar in 1 case and faciocervical scar in 6 cases.One case of scar was caused by radiotherapy for facial hemangioma.The size of defects after scar resection and release ranged from 12.0 cm×8.0 cm to 24.5 cm×8.0 cm.The operation was successfully completed in all cases.Three pre-expanded supraclavicular artery perforator plus flaps and 10 pre-expanded medial arm flaps,measuring 23.0 cm×7.0 cm to 27.0 cm×14.0 cm,were used as the first flap;five latissimus dorsi myocutaneous flaps and eight thoracodorsal artery perforator flaps,measuring 18.0 cm×7.0 cm to 25.0 cm×10.0 cm,were used as the second flap.One patient developed hematoma at two days after the pedicle division of medial arm flap and the flap survived completely after removal of the hematoma.Other flaps survived without complications and the incisions were healed in one stage.Patients were followed up for 1 to 48 months,with a median follow-up of 13 month

关 键 词：外科皮瓣 面颈部瘢痕 皮瓣连续转移 上臂内侧皮瓣 锁骨上动脉皮瓣 背阔肌肌皮瓣 胸背动脉穿支皮瓣 

分 类 号：R622[医药卫生—整形外科]