扩张后的上臂内侧逆行皮瓣在面部瘢痕挛缩合并鼻缺损修复中的应用

The clinical application of the expanded medial upper arm reverse flap in the repair of large facial scar with nasal defect

目的探讨扩张后的上臂内侧逆行皮瓣的血液供应,及其在大面积面部瘢痕挛缩合并鼻缺损修复中的应用。方法选择一侧无明显瘢痕的上臂,Ⅰ期手术将800ml扩张器置入上臂内侧深筋膜浅层;Ⅱ期分别将皮瓣两侧及近心端行延迟手术;Ⅲ期以肘部为蒂将延迟皮瓣转移至颜面、鼻部,皮瓣面积最大20cm×18cm;Ⅳ期行断蒂手术。结果自2000年3月至2006年7月,对11例大面积的面部瘢痕挛缩合并鼻缺损的患者进行修复。术后经1～3年的随访观察,所有患者的移植皮瓣完全成活,皮瓣色泽、质地与面部皮肤接近,移位器官复位良好,鼻外形满意。结论扩张后的上臂内侧逆行皮瓣能提供充足的组织量,将大面积的面部瘢痕挛缩和鼻缺损作为一个单元一次性进行修复,方法可行。但疗程较长,上肢与头部的强迫体位固定是其不足。

Objective To investigate the blood supply of the expanded reverse skin flap from medial upper arm and its application in the repair of large facial scar with nasal defect due to scar resection. Methods The operation was carried out for four steps. The 800 ml expander was implanted on the superficial layer of the deep fascia. Bilateral flaps and proximal part were performed the delaying respectively; The expanded medial upper arm reverse flap was removed to the defects; After being separated from donor site, the skin flap was transplanted to cover the facial and nasal defeet with maximal area of 20 cm×18 cm. Results Eleven cases of large facial scar with nasal defeet were treated by the method mentionde above from March, 2000 to July, 2006. After 1 ～3 years following up, the flaps of all cases survived completely with nearly normal skin color, texture and contour. Conclusion The expanded medial upper arm reverse flap is an effective and practical way to reconstruct the large facial scar with nasal defects. But longer treatment time and some obsessive position of upper limbs and head might he the disadvantages.