面部烧伤后瘢痕畸形的手术治疗策略

Surgical strategy for postburn facial scar contracture

面部是人体美表现最为集中的部位和最具特征性的暴露部位。面部烧伤后常导致程度不同的毁损和瘢痕畸形。非手术治疗主要适用于瘢痕增生期、手术等待期，以及作为手术后的辅助治疗。手术治疗的适应证主要有2类：一是各种瘢痕引起的面部器官缺损畸形和功能障碍，二是瘢痕对容貌的影响给患者造成精神和心理创伤。面部瘢痕挛缩常引起眼睑外翻、鼻孔闭塞和小口畸形，为保护角膜、保证通气及进食，须及时行眼睑外翻矫正、鼻孔开大和小口开大术等。其他面部瘢痕畸形应待瘢痕充血消退、软化稳定后再行手术，一般需6个月～1年或更长时间。

Postburn facial sear eontracture, which can cause disfigurement and functional impairment, is a major thera- peutic challenge. Except for some sears with severe functional impairments such as ectropion of lid, obstruction of nostril, microstomia, and so on, other kinds of facial scars are recommen- ded to be reconstructed after they become sufficiently softened. The selection of specific methods depends on the characteristics of the facial scar. The methods includ direct closure after resection, full or split-thickness skin transplantation, pedicled flap, distant flap, and free flap transfer, and tissue expansion. For the resurfacing of subtotal or total face deformity, composite facial tissue allotransplantation and prefabricated flap combined with tissue expansion and autologous fat injection are increasingly used to improve the facial aesthetic and functional outcome.