双侧颞浅血管同期预构颈区扩张皮瓣治疗双侧面部瘢痕挛缩畸形
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[摘要]目的:介绍应用颈区双蒂预构皮瓣治疗面部瘢痕畸形的方法。方法：自2006年以来，应用双侧颞浅血管束预构颈区扩张皮瓣，形成颈区左右侧双蒂皮瓣，转移修复面部瘢痕畸形13 例26侧，均为男性，年龄19～26岁。治疗时长平均为4月余。患者共同特点为：全颜面烧伤或烫伤后瘢痕挛缩畸形，面中部较严重，包括：睑外翻、鼻部分缺损畸形、口周瘢痕畸形等，颈部皮肤完好。治疗分两期，Ⅰ期：双侧颞浅血管预构颈区皮瓣，颈区皮肤扩张器植入术，扩张器注水3月余；Ⅱ期：双侧面部瘢痕挛缩畸形矫正，颈区双蒂预构扩张皮瓣转移术。设计预构扩张皮瓣最大单侧面积为：12cm×8cm。结果：26侧皮瓣均完全成活，皮瓣血供良好，供区可直接缝合，面部瘢痕挛缩得到松解。12个月后，随访5例10侧，修复效果良好，患者满意。结论：同期应用双侧颞浅血管预构颈区扩张皮瓣可同期修复双侧面部瘢痕挛缩畸形，是一种可靠的治疗面部瘢痕畸形的方法。
[关键词]预构皮瓣；颈部扩张皮瓣； 面部瘢痕
[中图分类号]R622[文献标识码]A [文章编号]1008-6455(2009)02-0141-03
, 百拇医药
Application of the prefabricated cervical expanded flap with bilateral superficial temporal vascular implantation to repair the bilateral facial scar
ZHOU Chuan-de, LI Yang-qun, YANG Zhe, LI Qiang,CHEN Wen, LI Feng-yong, TANG Yong
(The Tenth Plastic Department of Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China)
Abstract:ObjectiveTo investigate the feasibility of the bilateral prefabricated cervicalexpanded flap in the bilateral facial scar reparation. MethodsFrom 2006,13 cases of bilateral facial scar were reconstructed byapplication of the prefabricated cervical expanded flap with bilateral superficial temporal vascular implantation. The age ofpatients were 19-26 years and all of them were male.About 4 months to finish the treatment.The clinical aspect were that whole facial cicatricial contracture after burn. The operation was completed in two steps: ①To transfer the bilateral superficial temporal vascular through the subcutaneous tunnel into cervical area. At the same time, implant expander into the surface layer of the platysma.②After 3 months skin expansion, resect the bilateral facial scar and transfer the prefabricated island expanded flaps pedicled with bilateral superficial temporal vascular to repair the soft tissues defect .The maximal lateral area of the flap is 12cm×8cm.ResultsTotal 26 cases of prefabricated cervical expanded flap were survival and facial scar was reparation. After 12months, bilateral facial of five cases followed-up and acquired good effect. The scars at the donor sites were acceptable.ConclusionsApplication of the prefabricated cervical expanded flap with bilateral superficial temporal vascular implantation is a reliable reconstructive option for a large area of bilateral facial scar.
, http://www.100md.com
Key words:prefabricated flap;cervical expanded flap;facial scar
面部瘢痕挛缩畸形的临床治疗，可供选择的手段较多，各种方法优劣不再赘述。本文介绍应用双侧颞浅血管同期预构颈区扩张皮瓣，转移、治疗面部瘢痕挛缩畸形的方法。自2006年以来，用相同的方法完成13例26侧，获良好疗效。手术分两期，用时4个月余，即Ⅰ期：双侧颞浅血管预构颈区皮瓣，颈区皮肤扩张器植入术；Ⅱ期：面部瘢痕挛缩畸形矫正，颈区双蒂预构扩张皮瓣转移术。
1临床资料
1.1一般资料：本组计13例，男性，年龄为19～26岁，损伤原因：烧、烫伤。临床表现：面部瘢痕，睑闭合不全，鼻翼缺损，鼻尖、鼻孔畸形，张口受限，唇外翻等，颈部完好未损，双侧颞浅血管走行区域损伤表浅。经入院常规检查未发现手术禁忌。本组共完成26侧颈区预构扩张皮瓣面部转移，皮瓣完全成活，随访1年5例双侧面部皮瓣，无臃肿、下垂及蒂部牵拉，为后续治疗提供良好条件。
, 百拇医药
1.2手术方法
1.2.1 Ⅰ期手术：双侧颞浅血管颈区预构，颈区皮肤扩张器置入术。①术前准备：应用激光多普勒血流仪探测双侧颞浅血管顶支走行并标注，手术选用全身麻醉；②颞区手术：沿标注线切开双侧皮肤(头皮)，解剖双侧颞浅血管，顶支远端以能够翻转下移至颈颌缘下2～3cm为度；掀起颞浅血管筋膜蒂至颧弓上缘，血管两缘各携带筋膜约1cm；③转移隧道形成：于颞区切口下缘沿耳前-下颌角-颌颈缘做皮下锐性分离，宽约3cm,与颈区切口重合；④颈区手术：于颌颈角水平做切口，左右各一，长约5cm；皮下锐性分离，左右贯通，植入600ml或800ml皮肤扩张器两只，可重叠放置；⑤血管预构：颞浅血管筋膜蒂经皮下隧道翻转至颈区切口，远端筋膜缘越过切口，与颈区皮下藕合缝合；耦合长度约2～3cm。术毕每只扩张器各注水约20～40ml。, 百拇医药(周传德 李养群 杨 喆 李 强 陈 文 李峰永 唐 勇)