游离皮瓣联合预构扩张皮瓣修复面颈部瘢痕

Repair of Faciocervical Scar with the Combination of Free Flap and Prefabricated Expanded Flap

目的:探讨游离皮瓣联合预构扩张皮瓣修复面颈部大面积瘢痕的疗效。方法:2017年6月-2019年6月,应用游离皮瓣联合预构扩张皮瓣修复6例烧伤后患者的面颈部瘢痕。一期设计游离皮瓣修复颈部瘢痕的同时于前躯正常皮肤处设计预构扩张皮瓣,取长约10~14cm的旋股外侧动脉降支血管蒂作为预置血管,将扩张器及预置血管一同置入预扩张的皮瓣内。待扩张器扩张满意后,行二期手术,修复面部瘢痕。结果:分区(面部为一区,颈部为另一区)分次(一期修复颈部瘢痕及置入扩张器,待扩张器扩张满意后二期修复面部瘢痕)修复面颈部大面积瘢痕,两个皮瓣融合良好,未发生术后并发症。随访3~12个月,面部术区与周围皮肤色泽质地及厚薄均相近,张口及表情功能良好,下颌弧度接近正常,颈部活动得到明显改善,两处供瓣区仅留两条线性瘢痕。结论:游离皮瓣联合预构扩张皮瓣是修复面颈部大面积瘢痕较好的方法,供区损伤小,患者满意。

Objective To explore the effect of free flap combined with prefabricated expanded flap in the repair of large faciocervical scar.Methods From June 2017 to June 2019,6 patients suffered from faciocervical scars were included.Scars were repaired by free flap combined with prefabricated expanded flap.In the first stage,scar in neck was removed and repaired by free flap,and expander was implanted into adjacent area.In the meantime,the descending branch of the lateral circumflex femoral artery with a length of about 10-14cm was taken as the preset blood vessel.Anastomosis was done and vessels were put superior to the expander.When the expansion was satisfying,patients went through the second stage surgery.The bridging free flap was taken to repair the scar of face.Results The faciocervical area was divided into two districts as facial district(Ⅰdistrict)and cervical district(Ⅱdistrict).In the first stage,scar in cervical district was removed and repaired,expander was implanted.In the second stage,scar in facial district was repaired.Two flaps were connected and healed well without complications.Patients were followed up for 3-12 months.It was found that the color,texture and thickness of the flap in face were similar to the surrounding area.Mouth opening and facial expression were good.The mandible curve was close to normal.The neck movement was significantly improved than before.Only linear scars were left in the donor sites.Conclusion Free flap combined with prefabricated expanded flap is a promising method to repair large area of faciocervial scar with minor damage in the donor site.