游离胸背动脉穿支皮瓣整复面部亚单位大面积瘢痕的临床效果

Clinical effect of free thoracodorsal artery perforator flap in reconstructing large scar on the facial subunit

目的探讨胸背动脉穿支皮瓣游离移植整复面部亚单位大面积瘢痕的临床疗效。方法2014年4月—2018年3月,宁波市第六医院收治7例面部大面积瘢痕患者,其中男3例、女4例,年龄31~49岁,累及额部4例、颏颈部3例。采用彩色多普勒超声行胸背动脉穿支血管定位后,根据面部亚单位修复原则行瘢痕切除,形成的创面面积为8 cm×6 cm^21 cm×8 cm,切取面积为9 cm×7 cm^22 cm×9 cm游离胸背动脉穿支皮瓣修复。供区直接缝合。记录术中探查穿支血管位置与术前定位是否相符、皮瓣成活情况,随访观察皮瓣色泽、质地、外观及供区愈合情况、瘢痕形成情况、功能情况。结果7例患者术中探查穿支血管位置均与术前彩色多普勒超声定位相符。7例患者皮瓣术后均顺利成活。术后随访12~18个月,皮瓣色泽与受区周围皮肤相似,质地柔软,无明显挛缩,其中4例皮瓣外观轻度臃肿。7例患者皮瓣供区术后均愈合,无明显瘢痕增生,肩关节功能无明显影响。结论胸背动脉穿支皮瓣穿支血管解剖较恒定,皮瓣可切取面积大,且皮瓣质地柔软、外观良好、供区隐蔽,是面部亚单位大面积瘢痕整复的良好选择。

Objective To explore the clinical effect of free transplantation of thoracodorsal artery perforator flap in reconstructing large scar on the facial subunit.Methods From April 2014 to March 2018,7 patients with large facial scar were admitted to Ningbo NO.6 Hospital,including 3 males and 4 females,aged from 31 to 49 years,4 with frontal involvement and 3 with chin and neck.Color Doppler ultrasound was used for the positioning of the thoracodorsal artery perforating vessel,and scar resection was performed according to the principle of facial subunit repair.The wound area was 8 cm×6 cm-21 cm×8 cm,and the wound was repaired with the free thoracodorsal artery perforator flap in the area of 9 cm×7 cm-22 cm×9 cm.The donor site was closed directly by suturing.The consistency of the location of the perforating vessel explored during the operation with its preoperative positioning and the flap survival were recorded.The color,texture,and appearance of the flap and the healing condition,scar formation,and function of the donor area were observed during follow-up.Results The locations of the perforating vessels of 7 patients explored during the operation were consistent with those positioned by color Doppler ultrasound before the operation.All the flaps of the 7 cases survived successfully after operation.Postoperative follow-up of 12-18 months showed that the flap color was similar to the surrounding skin of the recipient area,with soft texture and no obvious contracture.Slight bloated appearance was observed in the flaps of 4 cases.All the 7 patients had postoperative healing of the flap donor site without obvious scar hyperplasia or influence on shoulder joint function.Conclusions The anatomy of the perforating vessel of the thoracodorsal artery perforator flap is relatively constant and the flap can be cut in large area with soft texture,good appearance,and concealed donor area,which is a good choice for reconstructing large scar on the facial subunit.