胸三角皮瓣并自体脂肪移植修复颌面部大面积缺损畸形

Expanded Deltopectoral Prefabricated Flaps and Autologous Fat Transplantation for Aesthetic Repair of Large Facial Defect Deformity

目的:探讨颌面部皮肤软组织大面积缺损凹陷的理想修复方法。方法:本组6例均为爆炸伤后颌面部皮肤软组织缺损及严重凹陷畸形,采用胸三角皮肤扩张形成带蒂皮瓣修复上述皮肤缺损及自体脂肪移植纠正残存凹陷畸形。手术分五步进行:1.胸三角深筋膜浅层埋植500 mL～800 mL皮肤扩张器并注水扩张3个月。2.根据面颈部预计皮肤缺损大小及形状作皮瓣预制并面部局部皮瓣纠正器官移位。3.带蒂皮瓣转移修复颌面部缺损。4.蒂部延迟及断蒂微整形。5.自体脂肪移植。结果:所有皮瓣成活良好,皮瓣色质接近面颈部周围正常皮肤,缺损畸形修复,外观形态好,供区直接缝合无需植皮,取得了较好的面部改观效果。结论:对于面部大面积皮肤软组织缺损,合并面部凹陷、面部器官缺损及移位,采取胸三角扩张延迟预制皮瓣并自体脂肪移植修复可取得良好的整复效果,为颌面部战创伤畸形提供了理想的修复方法。

Objective To explore the ideal method of large area concave in facial skin and soft tissue. Methods： 6 cases of maxillofacial soft tissue defect and severe depression after explosive injury were applied by deltopectoral skin expansion forming pedicled flap to repair the defected skin and autologous fat transplantation corrected residual deformity. Operation was carried out in five steps： 1~ was to implant 500 mL-800 mL skin expansion in deltopectoral fascia superficial and expand for 3 months. 2~ were to correct facial organs shift using prefabrication flap and local flap according to the defect skin size and shape in the face and neck. 3~ were to transfer pedicled skin flap to repair maxillofacial defects. Fourth was to delay unclipping pedicle and micro plastic pedicle. Fifth was autologous fat transplantation. Results： All flaps survived well, and were close to the face and neck skin color of the surrounding normal skin, defect and deformity were repaired, appearance were good, the donor sites were sutured directly, without skin grafting, received improved effect in face. Conclusion： For a large area of skin and soft tissue facial defects combining facial depression, facial organ defects and shifting, deltopectoral flap expansion delay and autologous fat transplantation are an ideal method to repair facial depression defect of large area skin and soft group.