扩张术在头面部外伤性软组织缺损修复中的早期应用

Early application of tissue expansion in repair of traumatic soft tissue defects in the head and face

目的探讨在头面部外伤性软组织缺损早期应用扩张术的效果。方法对18例头面部软组织缺损患者采用一期清创，缺损旷置或者简单的采用头皮刃厚皮片移植覆盖，同时在缺损旁边埋置扩张器；二期扩张皮瓣局部转移修复缺损创面，观察治疗效果并统计并发症发生率。结果18例头面部软组织缺损患者，共埋置22个扩张器，平均扩张时间74．3d（53～96d），术后随访平均时间为15个月（3～67个月）。所有的扩张皮瓣均成活，色泽、质地和外形均良好。除1例扩张器出现感染外，未出现其他扩张器相关并发症，感染发生率5．56％。结论头面部外伤性软组织缺损早期进行清创，埋置扩张器，二期扩张皮瓣修复缺损，不仅能减少不必要的供区损害，获得相同或类似的组织修复，同时并不会增加感染的发生率。

Objective To explore a novel strategy to repair traumatic soft tissue defects in the head and face by tissue expansion in the early stage. Methods Eighteen patients with traumatic soft tissue defects were treated with thorough debridement leaving the wound unclosed or simply closed with thin split-thickness scalp skin grafting, and adjacent expander implantation in the early stage and expanded flap transposition in the second stage. Results There were 11 male patients and 7 female patients ranging in age from 3.5 to 40 years [mean, （19.4±12.2） years], with average 15 months follow-up （range, 3-67 months）. The average expansion time was 74.3 days （range, 53-96 days）. The total of 18 patients with 22 expanders were treated with satisfactory results. All the flaps survived and the skin color, texture and contour well matched to those of the peripheral tissue. Only one complication of infection happened in the 18 cases （5.56%） and total 22 expanders （4.55%）, which was similar to the rate reported in the literature. There were no any other complications related to the expander. Conclusions Debridement and tissue expansion in the early stage have been proved a more effective strategy to repair traumatic soft tissue defects in the head and face, which can not only achieve satisfactory color, unbulky and well matched texture similar to normal, but also can avoid unnecessary donor site injuries and does not increase the infection rate of tissue expansion.