预扩张头皮瓣在面颈部病损修复中的应用

Application of pre-expanded scalp flap in reconstruction of faciocervical defects

目的探讨扩张头皮瓣在修复面颈部病损中的作用。方法2012年1月至2023年10月,空军军医大学西京医院整形外科利用预扩张头皮瓣修复面部及颏颈部病损50例。Ⅰ期手术根据病损位置及大小在帽状腱膜下埋置扩张器并规律注水。Ⅱ期手术包括:应用额顶部扩张头皮瓣滑行推进修复额部病损;应用颞顶部扩张头皮瓣,以单侧颞浅动脉为蒂,转移修复颞部及面部病损;应用预扩张顶部头皮瓣,以双侧颞浅动脉为蒂转移修复颏颈部病损。Ⅲ期手术包括皮瓣转移术后3周延迟及断蒂,拆线后2周开始激光脱毛治疗。统计手术并发症,观察手术治疗效果。结果本组共50例,其中额部22例,颞部及面颊部18例,颏颈部10例。Ⅰ期手术血肿1例,感染1例,Ⅱ期皮瓣转移术后血运障碍3例,扩张皮瓣面积5 cm×5 cm~12 cm×30 cm。术后随访2~30个月,转移皮瓣颜色、质地与受区接近,供区无明显瘢痕及畸形。结论预扩张头皮瓣能提供与面颈部皮肤颜色、质地接近的皮肤组织,是修复面部病损的理想方法之一。

Objective To investigate the effect of pre-expanded scalp flaps in repairing faciocervical defects.Methods From January 2012 to October 2023,50 patients with faciocervical defects were treated with pre-expanded scalp flaps in the Department of Plastic Surgery,Xijing Hospital,Air Force Medical University.In stage one,appropriate tissue expander was implanted under galea aponeurotica and injected regularly according to the location and size of the lesion.In stage two,the expanded scalp was transferred to repair facial lesions.Forehead lesions were repaired by advancement scalp flap;based on unilateral superficial temporal artery,cheek and tempus lesions were repaired by expanded tempus scalp and the mentum lesions were repaired by expanded scalp flap based on bilateral superficial temporal artery.In stage three,the pedicle was cut off 3 weeks later if necessary.Laser hair removal was performed 2 weeks after removing the suture.The complications were counted and the surgical results were recorded.Results There were 50 cases in this study,including 22 forehead lesions,18 cheek and tempus lesions and 10 mentum lesions.One case of hematoma and 1 case of infection occurred in stage one,and 3 cases of dysvascularization occurred in stage two after scalp flap transfer.The area of expanded scalp flaps ranged from 5 cm×5 cm to 12 cm×30 cm.The color and texture of the transferred flap were close to the recipient area after 2 to 30 months of follow up,and there was no obvious scar and deformity in the donor site.Conclusion Pre-expanded scalp flap can provide skin tissue similar to the color and texture of faciocervical skin,and it is a promising procedure in reconstruction of faciocervical defects.