上臂内侧扩张皮瓣修复面颈部瘢痕

FACIAL AND CERVICAL RECONSTRACTIONS USING EXPANDED FLAP FROM MEDIAL UPPER ARM

目的总结上臂内侧扩张皮瓣用于治疗面颈部瘢痕挛缩的方法及临床疗效。方法2000年5月-2007年2月,收治20例面颈部瘢痕挛缩患者。男12例,女8例;年龄7～42岁。病程9个月～20年。瘢痕范围8cm×6cm～22cm×18cm。一期手术于上臂内侧深筋膜浅层植入扩张器。二期手术切除松解面颈部瘢痕,采用9cm×7cm～24cm×18cm上臂内侧扩张皮瓣瓦合3.5cm×2.5cm～8.0cm×6.0cm瘢痕组织瓣带蒂移位修复瘢痕切除后创面。三期手术将扩张皮瓣断蒂,切除剩余瘢痕。结果患者术后供受区均Ⅰ期愈合,皮瓣及植皮均成活。供区瘢痕不明显,无继发畸形。16例获随访3～24个月,皮瓣质地、色泽与面颈部接近。面部器官移位复位满意,颏颈角形态流畅,颈部功能完全重建,无术后并发症发生。结论将扩张器植于上臂内侧皮肤深筋膜浅层形成上臂内侧扩张皮瓣,用于修复面颈部瘢痕挛缩,修复疗效满意,但治疗所需时间较长,且需强迫体位固定。

Objective To investigate the blood supply of the expanded skin flap from the medial upper arm and its application for the repair of facial and cervical scar. Methods From May 2000 to February 2007, 20 cases （12 males and 8 females; aging from 7 to 42 years） of facial and cervical scar were treated with the expender flap from medial upper arm. The disease course was 9 months to 20 years. The size of the scar was 8 cm × 6 cm- 22 cm × 18 cm. The operation was carried out for three steps： ① The expander was embed under the superior proper fascia. ② The scar in the face and cervix was loosed and dissected. Combined the expanded skin flap from the medial upper arm（the size of the flap was 9 cm × 7 cm - 24 cm × 18 cm） in which the blood supply to the flap was the superior collateral artery and the attributive branches of the basilica with auxiliary veins for blood collection with partial scar flap （3.5 cm × 2.5 cm - 8.0 cm × 6.0 cm） was harvested and transferred onto the facial and cervical defect. ③ After being cut off the pedide, the scar was dissected. The expanded flap was employed to cover the defect. Results After 3-24 months follow-up with 16 cases, all the grafted skin flaps survived at least with nearly normal skin color, texture and contour. The scars at the donor sites were acceptable. The function and appearance of the face and cervix was improved significantly. No surgery-related significant complications were observed. Conclusion Repair of facial and cervical scar with the medial upper arm expanded skin flap is a plausible reconstructive option for head and face reconstructions. However, a longer surgery time and some restrictive motion of the harvested upper limbs might be a disadvantage.