扩张预制超薄穿支皮瓣在面颈部瘢痕修复中的研究及应用

Clinical application of prefabricated super-thin perforator flaps after expansion in the reconstruction of facial and cervical scar

目的 探讨一种将扩张皮瓣、穿支皮瓣与超薄皮瓣技术相结合的扩张预制超薄穿支皮瓣,在面颈部广泛性瘢痕治疗中的效果.方法 一期术前应用多排螺旋CT（MDCT）、多普勒超声血流探测仪定位穿支血管的部位及走行,于真皮下血管网以下为分离层次埋置扩张器,二期以穿支血管为蒂,设计扩张超薄穿支皮瓣,修复面颈部大面积瘢痕畸形及皮肤缺损.结果2005至2013年对26例面颈部广泛性瘢痕患者以扩张超薄穿支皮瓣修复,包括颈肩背皮瓣9例、颈胸皮瓣5例、面颈部皮瓣12例,结果 仅1例皮瓣远端坏死,余25例皮瓣均成活良好.其中颈肩背跨区供血扩张预制超薄穿支皮瓣的最大面积为35 cm×10 cm,蒂为8 cm×4 cm.术后随访6个月至3年,所见皮瓣厚度薄于一般扩张皮瓣,避免了二期皮瓣修薄,重建的面颈部轮廓结构分明,表情传递及五官功能良好.结论 扩张预制超薄穿支皮瓣在重塑局部轮廓、再现精细表情等方面呈现出明显的优势,对于面颈部广泛性瘢痕及大面积皮肤缺损修复是一种非常实用、安全的组织修复方法.

Objective To explore a combined application of tissue expansion,perforator flaps and super-thin flaps in reconstruction of extensive face and neck scars.Methods In the first stage,the position and course of the perforators were confirmed with the multi-detector computed tomography （MDCT） and color Doppler ultrasound.The expanders were implanted between subdermal vascular plexus and superficial fascia.In the second stage,the expanded super-thin perforator flaps were transferred to resurface the extensive defects and deformities in the face and neck.Results 26 cases with extensive facial and cervical scars were included in this study.Except for one case with necrosis at the distal end,the other 25 flaps survived completely.The maximum flap size was 35 cm × 10 cm with a pedicle of 8 cm × 4 cm.Long-term follow-up showed that this combined application provided thinner flap than the conventional pre-expanded flap,thus avoiding secondary flap debulking and revisions.All the patients got improvement in contours,facial features and emotional expression.Conclusions The combined application of tissue expansion,perforator flaps and super-thin flaps is a practical method which has advantages in feature recontouring and recovery of delicate emotions in reconstruction of extensive face and neck scars.