血管移植皮瓣预构技术在额部扩张皮瓣中的应用

Clinical application of the technique of flap prefabrication using vascular transfer in frontal expanded flap

目的寻求一种解决以颞浅血管额支为蒂的额部扩张岛状皮瓣术后容易出现静脉回流的方法。方法手术分两期进行。Ⅰ期，在额肌下剥离，形成适当大小的囊腔，然后以颞浅血管顶支为蒂，形成颞顶筋膜瓣，转移至额部皮瓣下，舒展固定于额肌下面，于筋膜瓣下埋置扩张器；Ⅱ期，取出扩张器，以颞浅血管额支和转移带血运的筋膜瓣为蒂，形成额部扩张岛状皮瓣，转移、修复面部皮肤缺损。结果自2004年以来，临床应用3例，均为烧伤后面部瘢痕患者，术后皮瓣全部成活，无静脉淤血等皮瓣回流不畅的情况出现。结论将血管移植皮瓣预构技术应用到传统的以颞浅血管额支为蒂的额部扩张岛状皮瓣，不增加治疗时间，可有效地缓解皮瓣移植后的静脉回流问题，是解决额部扩张岛状皮瓣术后静脉回流问题的有效方法之一。

Objective To explore a method for solving venous return （VR） which was caused by distension of frontal island skin flap pedicled on the superficial temporal vessels, Methods The operation was divided into two stages. At the first-stage operation, dissection underneath the frontal muscle was performed to form the soft tissue pocket with appropriate size, a temporoparietal fascia flap based on the parietal branches of the superficial temporal vessels was elevated and transferred to the soft tissue pocket and a tissue expander was placed under it; At the second-stage operation, tissue expander was removed, an expanded frontal island flap pedicled on the frontal branches and implanted parietal branches of the superficial temporal vessels was formed and transferred to repair the facial defect. Results Since 2004, 3 cases of post-burn facial scar were treated with this method. All flaps survived and no VR was observed postoperatively. Conclusion Application of the technique of flap prefabrication using vascular transfer is an effective method to relieving the VR problem without increasing time of therapy which was caused by distension of frontal island skin flap pedicled on the superficial temporal vessels.