扩张预构胸背动脉穿支皮瓣修复儿童颈部瘢痕

Fabricated expanded thoracodorsal artery perforator flap to repair cervical scar in children

目的 探讨修复儿童颈部瘢痕挛缩畸形的理想方法.方法 一期手术于颈部瘢痕周围以及背阔肌表面埋置扩张器,完成扩张后二期行颈部瘢痕切除、挛缩松解,用颈部局部扩张皮瓣修复部分创面后,解剖扩张预构的胸背动脉穿支皮瓣移植修复剩余创面,不损伤胸背神经内外侧支和背阔肌,供区直接拉拢缝合.结果 2007年6月至2009年10月,于临床应用10例,所有皮瓣均成活,颈部瘢痕松解后的刨面均一次性修复.随访3～30个月,皮瓣随生长发育而增长,畸形矫正完全且未再继发,皮瓣不臃肿,颏颈胸部形态良好,颜色差异不明显.供区瘢痕较轻,功能无影响.结论 扩张预构的胸背动脉穿支皮瓣游离移植修复儿童颈部较大面积瘢痕挛缩畸形,是较为理想的方法.

objective To investigate ideal methods to repair cervical cicatricial contracture in children.Methods The expanders were implanted subcutaneously around the cervical scar and above the latissimus.After expansion was completed,the cervical cicatricial contracture was released and the wound was covered with local expanded flaps and free expanded prefabricated thoracodorsal artery perforeator flap,leaving no injury to thoracodorsal nerves and latissimus.The wound at the donor site was closed directly.Results From July 2007 to October 2009,10 patients were treated.All the flaps survived completely.All the wounds were repaired totally and the deformities were corrected completely.The patients were followed up for 3-30 months.When the patients grew up,the flaps enlarged simultaneously.The flaps were not bulky and had a good color match.The scar at the donor site was inconspicuous with no functional morbidity.Conclusion The fabricated expanded thoracodorsal artery perforator flaps is an ideal method for severe cervical cicatricial contracture in children.