采用扩张桡动脉分叶皮瓣美学修复面部严重瘢痕挛缩畸形  

Aesthetically reconstructing facial severe scar contracture deformity with expanded radial artery lobulated flaps

作　　者：张警泓 刘剑毅 江旭品 杨通 黄书鹏 沈洁 王凡 张灿 黄梅莓 刘小强 刘天 张家平 ZHANG Jinghong;LIU Jianyi;JIANG Xupin;YANG Tong;HUANG Shupeng;SHEN Jie;WANG Fan;ZHANG Can;HUANG Meimei;LIU Xiaoqiang;LIU Tian;ZHANG Jiaping(Department of Plastic Surgery,State Key Laboratory of Trauma,Burns and Combined Injury,The First Affiliated Hospital of Army Medical University,Chongqing 400038,China)

机构地区：[1]陆军军医大学第一附属医院整形外科,重庆400038 [2]陆军军医大学第一附属医院创伤、烧伤与复合伤国家重点实验室,重庆400038

出　　处：《中国美容整形外科杂志》2023年第11期641-646,663,共7页Chinese Journal of Aesthetic and Plastic Surgery

摘　　要：目的探讨采用扩张的桡动脉分叶皮瓣一次性修复面部严重瘢痕挛缩畸形患者多器官亚单位的美学效果。方法回顾性分析自2020年5月至2022年5月,陆军军医大学第一附属医院整形外科收治的4例面部严重瘢痕挛缩患者的临床资料。均一期于前臂埋置扩张器并定期注水形成扩张桡动脉皮瓣;二期术前通过数字减影血管造影标记桡动脉穿支位置;术中切除并彻底松解面部瘢痕,对严重鼻畸形患者行自体肋软骨鼻支架搭建;根据术前穿支定位及面部继发创面大小,设计并切取扩张桡动脉分叶皮瓣行游离移植,一次性实现对面部多器官亚单位(两个及以上)的美学重建。术后随访观察6~12个月面部器官亚单位形态与美学特征,评估患者满意度、术后浅感觉恢复和瘢痕情况。结果4例患者共于前臂埋置扩张器4个,扩张倍数2.2~8.0倍,无扩张器破裂、皮肤坏死等并发症发生。术中利用分叶皮瓣修复4个亚单位患者1例(鼻部、口周、眼周、颏部),3个亚单位患者2例(鼻部、口周、眼周),2个亚单位患者1例(鼻部、眼周)术后皮瓣均成活,无严重血管危象发生;3例供区直接缝合,1例联合皮片移植封闭供区。术后随访6~12个月,皮瓣厚度、色泽等与周围组织相近,面部器官及其亚单位美学特征显著改善,触压觉、痛觉、温度觉均不同程度恢复,术区瘢痕评分显著改善,供区恢复较好,无明显并发症发生;患者术后满意度较高。结论采用扩张桡动脉分叶皮瓣可以一次性重构面部多器官亚单位,并取得良好的美学效果,是面部多器官严重瘢痕挛缩畸形美学修复的良好策略。Objective To explore reconstruct facial multi-subunits simultaneously using expanded radial artery lobulated flaps and its aesthetic outcomes.Methods From May 2020 to May 2022,we retrospectively analyzed the clinical data from 4 patients with extensive facial scars who had been admitted to Department of Plastic Surgery,The First Affiliated Hospital of Army Medical University.The procedure involved two stages:all patients underwent forearm expander implantation and regular water injection to form an expanded radial artery flap in stage I.In stage II,Digital subtraction angiography was used to mark the location of the radial artery perforator.During the operation,the scar was excised and loosened completely,construct autologous rib cartilage nasal stent for patients with severe nasal deformities,the free flap was then designed based on the location of the perforator and the extent of secondary trauma in the face and transplanted to achieve aesthetic reconstruction of multiple facial subunits(two or more)simultaneously.Follow up observation 6 to 12 months after surgery,we observe aesthetic characteristics of facial organs and subunits,evaluate the satisfaction degree of patients and condition of superficial sensation and scar.Results A total of 4 expanders were implanted in the forearms,with an expansion ratio ranging from 2.2 to 8.0 times.There were no complications such as expander rupture or skin necrosis.Intraoperatively,four subunits were repaired in 1 patient,three subunits were repaired in 2 patients and two subunits were repaired in 1 patient with lobulated free flaps.All flaps survived without severe vascular crisis,the donor area was directly closed in 3 patients,with 1 patient combined skin graft.Within a six-month follow-up,the flap thickness and color were similar to the surrounding tissues.Significant improvements of aesthetic characteristics and scar scores in surgical area were observed,alone with the recovery of sensation of pressure,pain and temperature to varying degrees.The donor area recovered w

关 键 词：桡动脉 分叶皮瓣 美学重构 面部 

分 类 号：R622[医药卫生—整形外科]