预扩张胸三角皮瓣修复面颈部病损的临床效果

Clinical effect of pre-expanded deltopectoral flap in the repair of faciocervical lesion and defect

目的:探讨采用预扩张胸三角皮瓣修复面颈部病损的临床效果。方法:2004年7月—2018年8月,空军军医大学第一附属医院收治面颈部病损患者355例,其中男200例、女155例,年龄4~48岁,以热力烧伤后瘢痕、Ⅲ型和Ⅳ型面颈部畸形为主。Ⅰ期行皮肤软组织扩张器置入术,根据病损的大小及位置,置入合适容量的扩张器对胸三角区域进行扩张;Ⅱ期为皮瓣带蒂转移术,待扩张器扩张至理想容量后,切除病损组织,依缺损面积(单侧缺损面积为7 cm×5 cm^17 cm×16 cm)设计皮瓣后带蒂转移,胸部供区切口直接拉拢缝合;待皮瓣成活后Ⅲ期行皮瓣延迟术及断蒂术,本组患者单个皮瓣面积8 cm×5 cm^20 cm×18 cm。统计本组患者使用皮瓣个数,扩张器个数、额定容量及扩张情况,各期手术间隔时间,皮瓣存活情况,各期手术并发症发生情况,随访情况。结果:本组患者共使用460个预扩张胸三角皮瓣,其中250例患者采用单侧皮瓣、105例患者采用双侧皮瓣,相应共使用460个扩张器,额定容量以500 mL(163个)和600 mL(142个)居多;扩张器的扩张倍数为额定容量的(1.14±0.19)倍。本组患者皮瓣扩张时间为(96±30)d,带蒂时间为(32±8)d,延迟时间为(7.5±1.6)d。本组患者术后并发症以感染(29例)、扩张器外露(18例)和血肿(10例)为主。随访6~120个月,患者皮瓣修复处弹性、质地和颜色与受区周围组织相近,面颈部对称、不臃肿。结论:通过超量扩张可获得的胸三角皮瓣面积较大,厚度较薄,弹性、质地和颜色与面颈部受区周围组织相近,可获得良好的面颈部外观,并发症以感染和扩张器外露为主,多见于Ⅰ期皮肤软组织扩张器置入术后。

Objective To explore the clinical effect of pre-expanded deltopectoral flap in the repair of faciocervical lesion and defect.Methods From July 2004 to August 2018,355 patients with faciocervical lesion and defect were admitted to the First Affiliated Hospital of Air Force Medical University,including 200 males and 155 females aged 4 to 48 years with major conditions including thermal burn scars,and typeⅢandⅣfacial-cervical deformities.During the stageⅠskin soft tissue expander implantation surgery,according to the size and location of lesion and defect,expanders with appropriate volume were placed to expand the deltopectoral area.During the stageⅡflap pedicled transposition surgery,after the expander was expanded to the desired volume,the impairment tissue was removed,the flap was designed according to the size of the defect(the unilateral defect area was 7 cm×5 cm to 17 cm×16 cm)and pedicled transposition was carried out.The incision in the chest donor area was directly sutured and closed.After the flap survived,stageⅢflap delay and pedicle division surgery was carried out.The area of one single flap was 8 cm×5 cm to 20 cm×18 cm.The numbers of flaps and expanders,rated volume and expansion of expander,the intervals between surgeries in each stage,flap survival,postoperative complications in surgeries in each stage,and follow-up were recorded and analyzed.Results A total of 460 pre-expanded deltopectoral flaps were used,including 250 unilateral flaps and 105 bilateral flaps.Totally 460 expanders were used in this group of patients.The rated volume was mostly 500 mL(163 expanders)and 600 mL(142 expanders).The expansion multiple of the expander was(1.14±0.19)times of the rated volume.The flap expansion time of the patients was(96±30)d,the pedicle time was(32±8)d,and the delay time was(7.5±1.6)d.The postoperative complications of patients mainly included infection(29 patients),expander exposure(18 patients),and hematoma(10 patients).During the follow-up of 6 to 120 months,the elasticity,texture,and color of the flaps of patients were similar to the surrounding tissue of the recipient area,and the face and neck were symmetrical,not bloated.Conclusions The deltopectoral flap obtained by overexpansion has a larger area and a thinner thickness,and the elasticity,texture,and color are similar to the surrounding tissue of the recipient area.After transfer,a stable appearance of the face and neck can be obtained.The main complications are infection and expander exposure,most of which occurred after stageⅠskin soft tissue expander implantation surgery.