颞颊部扩张皮瓣的手术设计

The design of the expanded flap for the repair of the temporal and cheek area

目的 探讨如何设计颞颊部的扩张皮瓣。方法 对 6 19例颞颊部的瘢痕、斑痣、血管瘤等皮肤病变切除后应用不同部位、不同转移方法的扩张皮瓣进行修复。额部以旋转皮瓣、面颊部以旋转及滑行皮瓣、颈部以易位皮瓣为主及胸部带蒂转移的手术设计。结果 8例扩张后胸三角皮瓣远端坏死 1～ 5cm ,其中 5例再次手术时皮瓣上移后未影响最终修复效果 ,3例补充植皮。 5例面部扩张皮瓣远端坏死 0 5～ 1cm ,4例行二期瘢痕切除缝合术 ,1例行补充植皮术。 4 1例发生扩张器感染外露 (占 6 6 2 % ) ,行二期手术时皮瓣面积稍有不足 ,其余均取得满意效果。结论 额部以旋转皮瓣、面颊部以旋转及滑行皮瓣、颈部以易位皮瓣为主的手术设计 ,以及胸三角皮瓣带蒂转移是修复面颊部皮肤病变切除术后创面的良好方法 ;周密的手术设计对术后效果及并发症的预防非常重要。

Objective To explore the design of an expanded flap at the temporal and cheek area. Methods\ The expanded flap was used for the repair of 619 temporal and cheek defects secondary to scar, nevus or hemangioma excision.In the frontal area, the rotational flap was usually used.For the repair of the cheek,the applied flap included the rotational, advanced,and transposition flap from the neck,as well as the pedicle flap from the thoracic area. Results\ Eight thoracic\|deltoid flaps had distal necrosis of 1～5 cm. Of them, 5 flaps were repositioned with subsequent good result; the other 3 flaps underwent skin grafting. The five facial expanded flaps showed distal necrosis of 0 5～1cm.Of them, 4 flaps occurred delayed healing, 1 flap underwent skin grafting. Expander extrusion happened in 41 cases(6 62%), which resulted in deficiency of the expanded area. Satisfactory results were achieved in all the other cases. Conclusions\ According to our experience, careful design of the flap is very important for obtaining better surgical results and decreasing complications.