扩张后皮瓣治疗口周瘢痕的几种方法探讨

Investigation on the various methods of pre-expanded skin flap in the reconstruction of perioral scar

目的探讨应用扩张后皮瓣治疗口周瘢痕的临床效果。方法回顾性分析2009年3月至2019年7月空军军医大学第一附属医院整形外科应用扩张后皮瓣治疗的口周瘢痕病例资料。所采用扩张皮瓣包括:扩张后局部皮瓣、扩张后胸三角皮瓣、扩张后颏下皮瓣和扩张后颞浅动脉额支皮瓣。手术一般分3期, 包括一期扩张器置入、二期扩张皮瓣设计与转移、三期皮瓣延迟与断蒂。其中扩张后局部皮瓣修复无需断蒂, 扩张后颞浅动脉额支皮瓣修复时根据需要进行选择性激光脱毛。术后观察转移皮瓣血运及存活情况, 并随访观察供、受区外观及功能。结果共纳入47例口周瘢痕患者, 男21例, 女26例, 年龄7~50岁, 平均20岁。扩张后局部皮瓣治疗8例, 扩张后胸三角皮瓣治疗25例, 扩张后胸三角皮瓣联合扩张后局部皮瓣治疗3例, 扩张后颏下皮瓣治疗5例, 扩张后颞浅动脉额支皮瓣治疗6例。术后随访3~108个月, 平均57个月, 所有患者口周瘢痕均获得修复, 张口受限得以有效治疗, 术后转移皮瓣色泽、质地与周围皮肤相近, 外形满意。结论扩张后皮瓣是治疗口周瘢痕的良好方法。

Objective To explore the clinical effect of pre-expanded flap on the treatment of perioral scar.Methods The clinical data on the treatment of perioral scar with pre-expanded flap in the Department of Plastic and Reconstructive Surgery of the First Affiliated Hospital of Air Force Medical University from March 2009 to July 2019 were analyzed retrospectively.The pre-expanded flap composed of the pre-expanded local flap,the pre-expanded deltopectoral flap,the pre-expanded submental flap,and the pre-expanded frontal branch flap of the superficial temporal artery.Generally,the surgical procedure was divided into three stages,which included stage one:skin soft tissue expander implantation;stage two:pre-expanded flap design and transfer;stage three:delay of pre-expanded skin flap,and the amputation of the pedicle.The pre-expanded local flap did not require cutting off the pedicle.Selective laser hair removal was applied to pre-expanded frontal branch flap of superficial temporal artery to repair the scar.The blood circulation and the survival of the metastatic flap were observed after the operation.The appearance and function of the donor and recipient areas were followed up.Results A total of 47 patients aged between 7 to 50 years old comprising 21 males and 26 females with perioral scars were enrolled,with an average age of 20 years old.Eight cases were treated with pre-expanded local flap.Twenty five cases were treated with pre-expanded deltopectoral flap,3 cases were treated with pre-expanded deltopectoral flap combined with a pre-expanded local skin flap,5 cases were treated with pre-expanded submental flap,6 cases were treated with pre-expanded frontal branch flap of the superficial temporal artery.Postoperative follow-up time ranged from 3 to 108 months(mean 57 months).In all the patients,the perioral scars were repaired,with significant alleviation in mouth opening limitation.The color and texture of the transferred flap were similar to the surrounding skin,and the appearance was satisfactory.Conclusions The pre-expanded flap is a good approach for the treatment of perioral scar.