全厚植皮与扩张胸三角皮瓣转移修复面部大面积皮肤缺损

Full-thickness skin grafting and expanded deltopectoral flap transfer to repair large area skin defects in face

目的对比胸三角扩张皮瓣及全厚皮片游离植皮修复面部皮肤软组织缺损的治疗效果。方法选取自2010年12月至2015年12月因外伤、瘢痕或肿瘤导致的面部皮肤软组织缺损患者共41例,分别采用面部全厚皮片游离植移(20例)及胸三角皮瓣扩张+皮瓣转移修复术(21例)。比较两组患者术后移植部位一般情况及并发症的发生率。结果采用全厚皮片游离移植患者中,1例出现小面积皮肤坏死,1例术后皮片挛缩致下睑外翻,2例出现轻微色素沉着;采用胸三角扩张皮瓣移植修复患者中,2例皮瓣远端出现小面积血运障碍,经高压氧治疗后缓解。所有患者术后随访1~3年,皮肤质地及弹性均较好,色泽自然。结论两种手术方法都存在比较明显的优缺点,应根据患者的缺损部位及面积选择适合的手术方法,以达到美学修复的目的。

Objective To compare the therapeutic effect between expanded deltopectoral flap and full-thickness skin graft in the repair of large area defects of the skin and soft tissue. Methods From December 2010 to December 2015, a total of 41 patients with facial skin defects caused by trauma, scar, or tumor underwent treatment in our department. Depending on the area of facial skin defect, 20 cases underwent full-thickness skin grafting and 21 cases underwent deltopectoral flap expansion combined with thoracic flap transfer and repair.The general condition and complications in the transplantation site between the two groups were compared postoperatively. Results In the full-thickness skin graft group, a small area of skin necrosis appeared in 1 case, 1 case developed lower eyelid ectropion due to postoperative skin contracture, and 2 cases had slight pigmentation. In the patients treated with expanded deltopectoral flap, a small area of necrosis appeared in the distal flap in 2 cases. This was relieved after hyperbaric oxygenation. All patients were followed up from 1 to 3 years. Skin texture and elasticity were good and the color was natural. Conclusion These two kinds of surgical methods have obvious advantages and disadvantages. It is advisable tochoose the appropriate surgical method based on the defect location and area, soas toachieve cosmetic repair.