颈胸部预构扩张皮瓣在颜面修复中的应用

Cervicothracic Prefabricated flaps for reconstruction of face and neck

目的探讨建立以旋股外侧动脉降支血管为蒂，以颈胸区皮肤为扩张对象的预构皮瓣技术用于重建颜面。方法选择严重颜面部烧伤的患者为治疗对象。手术分两期进行。一期手术时，切取以旋股外侧动脉降支为蒂的筋膜瓣，与面动脉或甲状腺上动脉吻合，植入颈胸部皮下，于筋膜瓣下放置皮肤扩张器。扩张完毕后，形成以植入血管为蒂的预构岛状超薄皮瓣，用于面颈部皮肤缺损的修复。术后随访重建颜面的肤色、质地、表情恢复情况。结果临床治疗9例患者。术中切取筋膜瓣的面积平均为6．3×11．2cm，经过平均16．7周扩张后，扩张器平均注液1670ml，预构皮瓣的面积为12cm×15cm～15×32cm。所有病例面颈部创面均有效覆盖，供瓣区直接拉拢缝合。二期术后皮瓣出现不同的程度静脉回流障碍，2例发生皮瓣远端边缘小部分坏死，3例行蒂部修整。术后随访，转移皮瓣与修复部位周围的皮肤色泽、质地接近，面部表情、形态恢复自然。供区大腿未出现肌力减弱或感觉异常现象。结论以含旋股外侧动脉降支的筋膜瓣为血管载体，结合组织扩张技术，于颈胸部形成的预构皮瓣是修复颜面部大面积皮肤缺损的有效方法。

Objective Objective To introduce a new prefabricated flap with matched colour, texture, thin enough thickness, large enough dimension and reliability for reconstruction of massive defect of face and neck. Methods The patients with massive scar of face and neck were selected for treatment with prefabricated flap. Flap prefabrication involved two stages. The ＂sandwich＂ structure including the descending branch of the lateral femoral circumflex vessels and surrounding muscle fascia was harvested from the thigh and anastomosed to superior thyroid artery or facial vessels. Flap prefabrication was performed by inserting the fascia flap between the cervicothoracic skin and the tissue expander placed beneath the skin. After a period of expansion, the flap was transferred to the recipicent site based on the implanted vessels. The results including complications were examined during follow-up. Results Nine patients received this treatment. The average dimensions of fascia flap harvested was 6.3 cm × 11.2 cm. After mean interval of 16.7 weeks, the expanders were filled to a mean volume of 1 670cc. The size of prefabricated flap ranged from 12 cm × 15 cm to 15 cm × 32 cm. In all cases, the flap efficiently covered the entire defect of the face and neck, and the donor site of the flap is closed primarily. All of the flaps developed venous congestion in some degree after the second operation. Partial flap necrosis occurred in two cases. Three flap was thinned to contour the bulky pedicle. During follow-up, the transferred flap was matched well to the adjacent skin. The reconstructed face restored nature contour and expression. Muscle weakness or paraesthesia was not found in the donor thigh. Conclusions Cervicothoracic Prefabricated Flap, is reliable and versatile in the reconstruction of massive soft tissue deficits with restoration nature surface and expression of the face and neck.