扩张皮瓣修复口周软组织缺损时预防器官变形的效果

Comprehensive prevention of organ deformation during the repair of perioral soft tissue defect with expanded skin flap

目的探讨扩张皮瓣修复口周软组织缺损时预防器官变形的方法。方法2015年4月至2019年12月,中国医学科学院整形外科医院面颈部整形美容一中心收治口周软组织病损患者76例(男35例,女41例,年龄3~62岁,平均24.5岁)。一期手术在邻近缺损部位埋置合适扩张器,注水扩张,二期手术将扩张皮瓣转移覆盖口周缺损创面,切除部分包膜,并将皮瓣固定于骨膜,恢复并固定口唇位置与形态,预防器官变形。结果随访6个月至4年,皮瓣全部成活。术前轻度唇外翻5例、中度2例、重度3例,术后轻、中度患者完全矫正,重度完全矫正1例,2例改善至轻度。术前口角移位15例,术后剩余3例。口唇变形矫正20例,占80.0%。术前无口唇变形51例,术后出现轻度唇外翻1例,口角移位2例,口唇变形预防成功48例,占94.1%。结论扩张皮瓣修复口周软组织缺损时,需多环节联合预防,可有效避免器官变形。

Objective To explore the method of preventing organ deformation when using expanded skin flap to repair perioral soft tissue defect.Methods From April 2015 to December 2019,76 patients with perioral soft tissue defects(35 males and 41 females,aged 3-62 years,with an average of 24.5 years)were admitted to the First Center of Cervicofacial Plastic and Reconstructive Surgery,Chinese Academy of Medical Sciences Plastic Surgery Hospital.In the first stage operation,suitable expander was embedded in the adjacent defect area,and saline was injected to expand regularly.The second-stage operation will transfer the expanded flap to cover the wound of perioral defect,remove part of the capsule,and fix the flap to the periosteum,aiming to recover and restore the position and shape of the lip and prevent organ deformation.Results After a follow-up of 6 months to 4 years,all flaps survived.There were 5 cases of mild eclabium,2 cases of moderate,3 cases of severe preoperatively,mild and moderate patients were completely corrected postoperatively,1 case of severe completely corrected,and 2 cases improved to mild.There were 15 cases of angulusoris displacementpreoperatively,3 cases remained after operation;the overall correction rate of lip deformation was 80%(20 cases).There were 51 cases without lip deformation preoperatively,1 case with mild eclabium and 2 cases with angulusoris displacement postoperatively.The success rate of preventing lip deformation was 94%(48 cases).Conclusions When using expanded skin flap to repair perioral soft tissue defect,joint prevention in multiple links can effectively avoid organ deformation.