扩张胸背动脉穿支皮瓣游离移植整复烧伤后颈部瘢痕挛缩畸形的临床效果

Clinical effects of free transplantation of expanded thoracodorsal artery perforator flaps in reconstructing cervical cicatrix contracture deformity after burns

目的探讨应用扩张胸背动脉穿支皮瓣游离移植整复烧伤后颈部瘢痕挛缩畸形的临床效果。方法采用回顾性观察性研究方法。2018年5月—2021年4月,空军军医大学第一附属医院收治11例符合入选标准的烧伤后颈部瘢痕挛缩畸形患者,其中男3例、女8例,年龄5~46岁,瘢痕挛缩畸形病程5个月~8年,颈部瘢痕挛缩程度为Ⅰ度者1例、Ⅱ度者9例、Ⅲ度者1例。Ⅰ期根据颈部瘢痕大小在背部置入1个额定容量为200~600 mL的长方形皮肤软组织扩张器(以下简称扩张器),扩张时间为4~12个月,总注射生理盐水量为扩张器额定容量的3.0~3.5倍。Ⅱ期切取面积为10 cm×7 cm~24 cm×13 cm的扩张胸背动脉穿支游离皮瓣,修复瘢痕切除松解后形成的面积为9 cm×6 cm~23 cm×12 cm的创面。将胸背动静脉的主干与面动静脉进行端端吻合,供区直接拉拢缝合。术后14 d观察皮瓣成活情况、皮瓣供区愈合情况;随访时观察皮瓣外观、瘢痕增生挛缩情况,颈部功能恢复情况,皮瓣供区瘢痕增生情况。结果术后14 d,10例患者皮瓣成活;1例患者皮瓣中央皮肤出现瘀斑和表皮坏死,经2周换药治疗后愈合。术后14 d,11例患者皮瓣供区均愈合良好。术后随访6~12个月,10例患者皮瓣质地、色泽与受区周围皮肤接近,1例患者皮瓣轻度臃肿;11例患者皮瓣和皮瓣供区瘢痕增生挛缩不明显,颈部功能恢复良好。结论采用扩张胸背动脉穿支皮瓣整复烧伤后颈部瘢痕挛缩畸形后,颈部外观、功能恢复良好,且皮瓣供区损伤小,值得临床借鉴应用。

Objective To explore the clinical effects of free transplantation of expanded thoracodorsal artery perforator flaps in reconstructing cervical cicatrix contracture deformity after burns.Methods A retrospective observational study was conducted.From May 2018 to April 2021,11 patients with cervical cicatrix contracture deformity after burns who met the inclusion criteria were admitted to the First Affiliated Hospital of Air Force Medical University,including 3 males and 8 females,aged 5 to 46 years,with a course of cervical cicatrix contracture deformity of 5 months to 8 years.The degree of cervical cicatrix contracture deformity was degreeⅠin one patient,degreeⅡin nine patients,and degreeⅢin one patient.In the first stage,according to the sizes of neck scars,one rectangular skin and soft tissue expander(hereinafter referred to as expander)with rated capacity of 200 to 600 mL was placed in the back.The expansion time was 4 to 12 months with the total normal saline injection volume being 3.0 to 3.5 times of the rated capacity of expander.In the second stage,free expanded thoracodorsal artery perforator flaps with areas of 10 cm×7 cm to 24 cm×13 cm were cut out to repair the wounds with areas of 9 cm×6 cm to 23 cm×12 cm which was formed after cervical cicatectomy.The main trunk of thoracodorsal artery and vein were selected for end-to-end anastomosis with facial artery and vein,and the donor sites were directly closed.The survival of flaps and healing of flap donor sites were observed on the 14th day post surgery.The appearances and cicatrix contracture deformity of the flaps,recovery of cervical function,and scar hyperplasia of donor sites were followed up.Results On the 14th day post surgery,the flaps of ten patients survived,while ecchymosis and epidermal necrosis occurred in the center of flap of one patient and healed 2 weeks after dressing change.On the 14th day post surgery,the flap donor sites of 11 patients all healed well.During the follow-up of 6-12 months post surgery,the flaps of ten patients were similar to the skin around the recipient site in texture and color,while the flap of one patient was slightly swollen.All of the 11 patients had good recovery of cervical function and no obvious scar hyperplasia nor contracture in the flaps or at the donor sites.Conclusions Application of expanded thoracodorsal artery perforator flaps can restore the appearance and function of the neck,and cause little damage to the donor site in reconstructing the cervical cicatrix contracture deformity after burns,which is worthy of clinical reference and application.