头面颈部深度创伤的皮瓣整形修复

Plastic repair of deep wounds of scalp, face and neck with different skin flaps

目的 探讨不同皮瓣修复头面颈部软组织缺损的效果.方法根据软组织缺损的大小、深度和形状采用局部皮瓣、扩张后皮瓣和游离皮瓣进行整形修复.结果 所有皮瓣均全部成活.外观功能均恢复,1例患者恶性肿瘤切除修复后复发,经再次手术治愈;1例头部鳞癌患者因年迈（75岁）,白细胞2900U,血小板4.5万,术后患者及家属均不愿行放射和化学治疗,致使颈部广泛转移后死亡.对其余患者随访6～12个月,外形自然,效果满意.结论 头面颈部虽然毗邻相连,但皮肤软组织缺损修复的观注点各异,面部以美观为重,即皮瓣修复后的平整程度和色泽要与受区相近;颈部侧重牵拉是否解除,颈部不同方向活动应灵活;头部应用带毛发皮瓣修复.只要掌握三区域各自的特点,选择恰当的皮瓣修复,均能取得外形自然美观的效果.

Objective To evaluate the effects of different skin flap for repairing skin and soft tissue de- fects of head, face and neck. Methods According to the lesion location, size and depth, all patients were re- paired with different flaps, including local skin flaps（ kite-like subcutaneous pedicle flap; nasolabial fold flap; lip flap; temporal flap ）, the expanded skin flap and free skin flap （forearm flap; anterolateral flap ）. Re suits Allflaps survived primarily after operation. After for 6 to 12 months following up, all patients were healed except for one case with the tumor recurrence which was cured by reoperation and the other one with neo- plasm metastasis and cytopenia who died without any radiotherapy or chemotherapy. Conclusion Scalp, face and neck are adjacent, but preoccupation of repair were different. The repair of the facial tissue defects focused on beautiful contour, the color and appearance of the skin flaps were matched well to the adjacent tissues; The repair of the neck tissue defects focused on the cervical contracture whether completely be released to obtain free cervical activity in different direction and natural contour; The repair of the scalp tissue defects should use the flap with hair, for the scalp and skull full-thickness and large defect, the repair focused on the coverage of the brain tissue and the hair repairing and skull repairing with peptide net should be performed secondarily. The ap- prehension of characteristics mentioned-above and choosing of the appropriate type skin flaps could achieve the cosmetic results.