双Z成形术矫正蹼颈畸形

Modified double Z plasties for correction of webbed neck defects

目的探讨采用双Z成形术矫正蹼颈缺陷的临床效果，并探讨该设计的原理及优越性。方法在耳后至乳突后发际设计一个Z成形术，并在其后下缘斜方形切除一部分带毛发的皮肤，另外在肩峰内上方设计一个与上述切口不连续的Z成形术，两个Z成形术经过转位后达到延长带状条索的目的。而部分带毛发的皮肤切除后，带状条索分别在乳突下部和锁骨中线处切断，中段向内侧回缩，与Z成形术结合从而使颈蹼消失。结果该方法仅需要较小范围的皮下剥离和少量的皮肤切除，切口隐蔽、剥离范围小、瘢痕轻微，无肥厚性瘢痕增生。共矫正蹼颈缺陷5例，其中男性1例，女性4例。随访1～11年，医患均满意。结论采用此方法治疗蹼颈畸形，不仅操作简便，在局部麻醉下就可以完成，而且具有美容效果。

Objective To study the clinical efficacy of bilateral double Z plasties for correction of the webbed neck defects, and to explore its principle and superiority to other reported methods. Methods We designed a small Z plasty over the mastoid with a rhomboidal skin resection of infra-hairline, and another large Z plasty transposition skin flap in superior-acromion. The tight band of fibrous webbing was separately cut and undermined at infra-mastoid and midclavicular line, wherein the middle part of the band retracted medially. Results It involved narrow tunneled anterolateral skin undermining and minimal skin resections from the nape of the neck, and posterior rhomboidal skin excision avoided the unnatural and noticeable lateral scars with normal skin extended in the middle of the webbing. The resultant scar was hidden and mild with no hypertrophic scars. A total of 5 cases were repaired, in which 1 case was male, 4 others were females. Follow-up for 1 to 11 years showed that the appearance and function in the repaired sites by using the bilateral double Z-plasties for repair of webbed neck deformity were very satisfactory. Conclusion We propose the use of this technique for correction of webbed neck deformities with simplified manipulation and cosmetic effect.