基于“MLT”原则采用扩张皮瓣整复面颈部瘢痕的方法及其临床效果  

Methods and clinical effects of reconstructing facial and cervical scars with expanded flaps based on the"MLT"principle

作　　者：陶明秋 黄覛韬 梁鹏飞[1] 张明华[1] 张丕红[1] 何志友 曾纪章[1] 周捷[1] 崔旭[1] 郭乐 周思拓 杨燕 谢庭鸿[1] 黄晓元[1] Tao Mingqiu;Huang Mitao;Liang Pengfei;Zhang Minghua;Zhang Pihong;He Zhiyou;Zeng Jizhang;Zhou Jie;Cui Xu;Guo Le;Zhou Situo;Yang Yan;Xie Tinghong;Huang Xiaoyuan(Department of Burns and Plastic Surgery,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院烧伤整形科,长沙410008

出　　处：《中华烧伤与创面修复杂志》2024年第7期657-664,共8页Chinese Journal of Burns And Wounds

基　　金：湖南省自然科学基金面上项目(2023JJ30909);湖南省自然科学基金青年基金项目(2022JJ40791)。

摘　　要：目的探讨基于“MLT”原则采用扩张皮瓣整复面颈部瘢痕的方法及其临床效果。方法该研究为回顾性观察性研究。2019年1月-2022年5月,中南大学湘雅医院收治74例符合入选标准的烧创伤后面颈部瘢痕患者,其中男38例、女36例,年龄5~58岁,单纯面部受累者24例、单纯颈部受累者24例、面部和颈部均受累者26例,瘢痕面积12~145 cm^(2)。遵循色泽、质地与面部相似;皮瓣面积足够大以修复整个缺损;皮肤组织足够薄,能传递表情,以利于面部形态和五官的塑形的“MLT”原则,Ⅰ期行皮肤软组织扩张器(以下简称扩张器)置入术,Ⅱ期行扩张器取出+瘢痕切除+皮瓣移植术修复继发创面,将皮瓣供区创面直接缝合。术后采用硅凝胶制剂、激光治疗等抗瘢痕增生。观察并记录扩张器扩张倍数、扩张周期,皮肤软组织扩张术并发症发生情况,以及采用的皮瓣类型、Ⅱ期术后皮瓣成活情况。术后随访,评估患者面颈部远期整复效果和皮瓣供、受区恢复情况。结果135个扩张器扩张倍数为1.36~3.00倍,扩张周期为6~14个月。行皮肤软组织扩张术期间,8例患者出现扩张器置入后切口愈合不良、7例患者出现扩张器破裂、5例患者出现扩张器置入后切口感染、3例患者出现扩张器外露、2例患者出现注射壶注水困难、1例患者出现注射壶漏水。8例患者采用颈横动脉与旋肩胛动脉双血供肩背部扩张皮瓣,11例患者采用颈横动脉前穿支扩张皮瓣,12例患者采用胸廓内动脉穿支扩张皮瓣,16例患者采用上胸部及颈部串联扩张皮瓣,5例患者采用胸背动脉穿支扩张皮瓣,22例患者采用邻近旋转推进扩张皮瓣。Ⅱ期术后,71例患者皮瓣完全成活;1例患者皮瓣出现血运障碍,经高压氧治疗后成活;2例患者皮瓣末端出现坏死,经换药后愈合。术后对42例患者随访3~24个月,皮瓣颜色、质地、厚度均佳,与受区周围正常皮肤组织相近,面Objective To explore the methods and clinical effects of reconstructing facial and cervical scars with expanded flaps based on the"MLT"principle.Methods The study was a retrospective observational study.From January 2019 to May 2022,74 patients with facial and cervical scars after burn or trauma injuries who met the inclusion criteria were admitted to Xiangya Hospital of Central South University,including 38 males and 36 females,aged from 5 to 58 years,including 24 patients with simple facial involvement,24 patients with simple cervical involvement,and 26 patients with both facial and cervical involvement,with scar area ranging from 12 to 145 cm^(2).By following the"MLT"principle(color and texture similar to the face;flap area large enough to reconstruct the entire defect;skin tissue thin enough to transmit the expression,so as to facilitate the shape of the face and five features);in the stageⅠsurgery,the skin and soft tissue expanders(hereinafter referred to as the expanders)were implanted,and in the stageⅡsurgery,the expander removal+scar resection+flap transplantation to repair the secondary wound was performed,and the wound in the donor area of flap was directly sutured.After operation,silicone gel preparation and laser therapy were used to prevent scar hyperplasia.The expansion ratio and time period of expanders,the occurrence of complications of skin and soft tissue expansion surgery,the type of flap used,and the survival of flap after the stageⅡsurgery were observed and recorded.The long-term effect of facial and cervical reconstruction and the recovery of donor area and recipient area of flap were evaluated during the postoperative follow-up after surgery.Results The expansion ratio of 135 expanders ranged from 1.36 to 3.00 times,and the expansion time period ranged from 6 to 14 months.During skin and soft tissue expansion surgery,8 patients had poor healing of incisions after expander placement,7 patients had expander rupture,5 patients had infection in incisions after expander placement,3 patient

关 键 词：瘢痕 外科皮瓣 烧伤 面部 颈 扩张术 创面修复 

分 类 号：R62[医药卫生—整形外科]