颞浅动脉及其分支组合式分叶及游离皮瓣修复头面部创面

Repair of the wounds in the head and face with combined polyfoliate and free flaps of superficial temporal artery and its branches

目的总结与分析颞浅动脉及其分支组合式分叶及游离皮瓣在头面部创面修复中的应用效果。方法选择2019年2月至2020年1月在湘雅常德医院整形美容烧伤科就诊的头面部皮肤肿物患者,应用颞浅动脉主干及其顶支、额支和额支的穿支进行不同组合,设计成分叶皮瓣和游离皮瓣,进行病损切除后创面修复。包括以颞浅动脉近端为蒂,顶支设计成轴向分叶皮瓣;以额支近端为蒂,额支穿支设计成轴向分叶皮瓣;以颞浅动脉近端为蒂,额支设计成轴向分叶皮瓣;以额支为蒂,颞浅动脉主干及顶支设计成分叶皮瓣;以顶支远端为蒂,颞浅动脉主干设计游离皮瓣。所有创面均直接拉拢缝合。术后观察供区和受区皮瓣成活情况,并对皮瓣外观及面部肿物是否复发进行随访。结果本组共纳入6例头面部皮肤肿物病例,男性5例,女性1例,年龄18~69岁,平均57岁。所有皮瓣均成活,术后随访1~10个月,皮瓣质地与周围皮肤相似,无色差,皮瓣及供区瘢痕不明显,修复效果满意。所有病例肿物无复发。结论以颞浅动脉及其分支进行不同组合设计成分叶和游离皮瓣,可灵活修复头面部创面,皮瓣与周边皮肤相似,供区可直接闭合,效果满意。

Objective To summarize and analyze the application effect of combined polyfoliate and free flaps of superficial temporal artery and its branches in the wounds on the head and face.Methods From February 2019 to January 2020,patients diagnosed with head and face skin tumors in the Department of Plastic Surgery of Xiangya Changde Hospital were selected.The lesions were excised,and the superficial temporal artery and its different branches(the parietal branch,the frontal branch,and the perforating branch of the frontal branch)were used to design polyfoliate and free flaps for wound repair.Patients were treated with polyfoliate flaps designed using the parietal or frontal branch with the proximal end of the trunk as the vascular pedicle,polyfoliate flap designed using the perforating branch of the frontal branch with the proximal end of the frontal branch as the vascular pedicle,polyfoliate flap designed using the trunk and parietal branch with the frontal branch as the vascular pedicle,and a free flap designed using the trunk with the proximal end of the parietal branch as the vascular pedicle.All donor sites of the flaps were closed primarily.The survival of the flaps were observed after surgery,and the appearance of the flaps and the recurrence of facial tumors were followed up.Results In this study,all the patients were aged 18 to 69 years with an average age of 57 years and were diagnosed with head and face skin tumors.Among the six patients,there were five men and one woman.All the flaps survived,and no tumor recurrence was noted during the postoperative follow-up period of 1 month to 10 months.The texture of these flaps was similar to the surrounding skin,with no color difference.In addition,no noticeable scar was noted on both the flaps and the donor sites.The outcome of the repair was satisfactory.Conclusions The design of polyfoliate and free flaps using different combinations of the superficial temporal artery and its branches can facilitate flexible repair of the wounds on the head and face.This method exhibits certain advantages,such as skin characteristics of the flaps similar to that of the surrounding skin,direct closure of the donor sites,and a satisfactory repair.