胸前区预扩张皮瓣对颌颈部瘢痕的修复应用

Application of pre-expanded skin flap in the anterior thoracic region to repair scar in the maxillofacial and cervical region

目的 探讨利用胸前区预扩张皮瓣修复颌颈部瘢痕的临床效果。方法 回顾性分析自2018年1月至2021年12月,空军军医大学第一附属医院(西京医院)整形外科采用预扩张的胸前区皮瓣修复27例颌颈部瘢痕患者,根据瘢痕涉及范围及面积,将胸前区轴型血管预扩张皮瓣分为2组:17例(21个扩张器)采用胸廓内动脉第2、3肋间穿支血管的预扩张胸三角皮瓣(以下简称胸三角皮瓣)修复下颌、颏、颌底部瘢痕;10例(10个扩张器)采用颈横动脉颈段皮支血管的预扩张颈横皮瓣(以下简称颈横皮瓣)修复颌底、颈部瘢痕。根据皮瓣轴型血管蒂长度特点来修复不同的瘢痕部位,均为采用一期手术皮瓣下埋置相应大小的扩张器,注水扩张2~6个月,二、三期手术采用扩张皮瓣修复相应部位瘢痕挛缩。结果 本组共27例患者,埋置扩张器31个;一期手术根据胸前区可利用扩张区域埋置相应容量扩张器,经2~6个月注水扩张,均顺利完成二期修复手术;术后皮瓣血运、颜色及皮瓣厚度均与受区完全契合,面颈部双侧对称性及局部功能、轮廓和形态均满意。预扩张的胸三角皮瓣对于下颌部修复的单侧皮瓣面积达16 cm×10 cm,预扩张的颈横皮瓣对于颈部修复的单侧皮瓣面积达18 cm×15 cm,术后皮瓣均成活,所有患者获随访6~36个月,无血肿、感染、坏死等并发症发生。结论 胸前区皮瓣是修复下颌、颈部瘢痕的最佳供区,经预扩张后可获得较大面积的修复皮瓣,移植后颜色、厚度均与受区相一致;其修复及重建后的颌颈部功能、外观恢复佳且轮廓清晰。

Objective To investigate the clinical effect and application of pre-expanded skin flap in the anterior thoracic region in the repair of maxillofacial and cervical scars. Methods Retrospective analysis from January 2018 to December 2021, 27 cases of maxillofacial and cervical scars were repaired with pre-expanded prothoracic skin flaps in of Plastic and Reconstructive Surgery, The First Affiliated Hospital of Air Force Medical University, the pre-expanded thoracic triangle skin flap with axial blood vessel was divided into two groups: 17 cases(21 sides) of pre-expanded thoracic triangle skin flap with internal thoracic artery, 2nd, 3rd intercostal perforators,10 cases(10 sides)were treated with the expanded transverse cervical flap, which was made from the cutaneous branch ofthe cervical segment of the transverse cervical artery, to repair the scar of the jaw. Chin and neck According to the length of axial vascular pedicle of the skin flap to repair different scar sites, all of them were treated with one-stage operation by implanting corresponding-sized expander under the skin flap and dilating with water for 2~6 months, in stage Ⅱ or Ⅲ, the expanded skin flap was used to repair the scar contracture. Results In this group, 31 dilators were implanted in 27 cases, and the corresponding volume dilators were implanted in the dilatation area ac cording to the prothoracic region during the first stage of operation, and the dilatation was completed successfully after 2~6 months of water injection The blood supply, color and thickness of the skin flap were by the recipient area. The symmetry of the face and neck and the local function, contour, and shape of the skin flap were satisfactory. The size of the pre-expanded thoracic triangle flap was 16 cm×10 cm for the unilateral flap of the mandible, and the pre-expanded transverse cervical flap was 18 cm×15 cm for the unilateral flap of the mandible. All the flaps survived after the operation, and no hematoma, infection, necrosis, or other complications occurred. Conclusion The anterior thoracic skin flap is the best donor site for repairing the scar on the mandible and neck. After pre-expansion, a large area of the skin flap can be obtained, and the color and thickness of the skin flap after transplantation are consistent with the recipient site, the blood supply and color are ensured after the operation. The function, appearance and contour of the jaw and neck recover well after reconstruction.