发卡状切口掀盖式皮瓣在项背部巨大脂肪垫整形术中的应用  

Application of hairpin shaped incision combined with cover-lifting flap in plasticsurgery of huge fat pad on nape and back

作　　者：张明月 陈王浩男 舒飞鸿 刘野 陶科融 张驰 游兴 孙广峰 ZHANG Mingyue;CHEN Wanghaonan;SHU Feihong;LIU Ye;TAO Kerong;ZHANG Chi;YOU Xing;SUN Guangfeng(Department of Burns and Plastic Surgery,the Second Affiliated Hospital of Zunyi Medical University,Zunyi Guizhou,563003,P.R.China;College of the First Clinical Institute,Zunyi Medical University,Zunyi Guizhou,563003,P.R.China)

机构地区：[1]遵义医科大学第二附属医院烧伤整形外科,贵州遵义563003 [2]遵义医科大学第一临床学院,贵州遵义563003

出　　处：《中国修复重建外科杂志》2023年第9期1133-1137,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：贵州省科技计划项目(黔科合基础-ZK[2022]一般629);遵义市科技计划项目[遵市科合HZ字(2020)58号];遵义医科大学2018年度学术新苗培养及创新探索专项项目[黔科合平台人才(2018)5772-065]。

摘　　要：目的探讨采用发卡状切口掀盖式皮瓣行项背部巨大脂肪垫整形术的疗效。方法2019年3月—2023年3月,收治10例项背部巨大脂肪垫患者。男1例,女9例;年龄39~57岁,平均52岁。患者项背部软组织隆起,MRI提示皮下脂肪增厚,项背部脂肪垫纵轴长度10.0~25.0 cm,平均14.1 cm;横轴长度6.0~15.0 cm,平均10.8 cm;脂肪厚度2.5~5.1 cm,平均3.9 cm。全身麻醉下患者取俯卧位,作发卡状切口,掀起皮瓣切除病灶行后项背部整形术。术后每2天换药。结果手术时间35~110 min,平均72 min;术中出血量35~80 mL,平均49.5 mL。术后2~5 d拔除引流管,平均3.4 d。切口均Ⅰ期愈合,无切口裂开、感染、皮下淤血、血肿等相关并发症发生。患者均获随访,随访时间2~24个月,平均12个月。患者项背部术区形态良好;切口瘢痕不明显,术后2个月根据温哥华瘢痕量表评估标准,切口瘢痕评分为3~5分,平均3.7分;颈部活动良好。随访期间无复发。结论采用发卡状切口掀盖式皮瓣行项背部巨大脂肪垫整形术具有充分显露脂肪垫、切口隐蔽、操作简便以及术后项背部形态自然等优点。Objective To explore the effectiveness of hairpin shaped incision combined with cover-lifting flap inplastic surgery of huge fat pad on nape and back.Methods Between March 2019 and March 2023,10 patients with hugefat pad on the nape and back were treated.There was 1 male and 9 females with an average age of 52 years(range,39-57years).All patients had soft tissue bulge on the nape and back.Preoperative MRI showed the subcutaneous fat thickening.The length of the longitudinal axis of the fat pad ranged from 10.0 to 25.0 cm(mean,14.1 cm),the length of the transverseaxis ranged from 6.0 to 15.0 cm(mean,10.8 cm);the thickness of the fat pad ranged from 2.5 to 5.1 cm(mean,3.9 cm).Under general anesthesia,the patient was placed in a prone position and a hairpin shaped incision was made.The flap waslifted to remove the fat pad according to the marked area.The dressing was changed every 2 days after operation.Results The operation time was 35-110 minutes(mean,72 minutes).The intraoperative blood loss was 35-80 mL(mean,49.5 mL).The drainage tube was removed at 2-5 days after operation(mean,3.4 days).All incisions healed by firstintention without incision dehiscence,infection,subcutaneous bruising,hematoma,or other related complications.Allpatients were followed up 2-24 months(mean,12 months).All patients had a good shape of the nape and back and nonoticeable scar on the incision.According to the Vancouver Scar Scale evaluation criteria,the incision scar score was 3-5(mean,3.7)at 2 months after operation.Patients had good neck movement with no recurrence.Conclusion For thehuge fat pad on the nape and back,the plastic surgery using hairpin shaped incision and cover-lifting flap has theadvantages of fully exposing the fat pad,concealed incision,simple operation,and natural shape of the nape and back afteroperation.

关 键 词：巨大脂肪垫 项背部 发卡状切口 掀盖式皮瓣 整形术 

分 类 号：R622[医药卫生—整形外科]