扩张后皮瓣修复面部瘢痕的手术设计

Surgical design for the repair of facial scars by dilated flaps

目的 探讨扩张后皮瓣修复面部瘢痕的手术设计。方法 回顾近年来笔者应用扩张后皮瓣修复面部瘢痕的患者。扩张后皮瓣的手术设计常采用直接推进皮瓣、旋转推进皮瓣和异位皮瓣。术中首先确定可供利用的扩张后新获得皮瓣的面积 ,同时测量出病损部位的面积。采用逆行设计 ,先以病损部位所需皮瓣大小及形态拓印一模板 ,在于扩张后新获得的皮瓣上标出拓下皮瓣的大小 ,在保证血供的基础上 ,适当调整 ,直至设计合理后切除病损处瘢痕 ,行皮瓣转移修复。不同的病损部位行不同的皮瓣设计 ,并强调应尽量减少供区的切口线 ,而且使切口在隐蔽处 ,顺皮纹。结果 本组 5 0例患者 ,瘢痕切除后行扩张后皮瓣修复 ,皮瓣成活良好 ,无继发畸形。随访 2 8例患者 ,皮瓣颜色、质地佳 ,切口瘢痕轻度增生。结论 合理设计扩张后皮瓣行转移修复面部瘢痕 。

Objective To investigate the satisfactory application of dilated flaps in the repair of facial scars. Methods A retrospective study was conducted to analyze our patients who had undergone surgery to repair their facial scars with dilated flaps. Direct propel flaps, rotation propel flaps and displacement flaps were usually used as dilated flaps provided that blood supply was ensured. During surgery, the available size of the dilated flap was first determined and at the same time the damaged area was measured. Retrograde design was used and firstly a model cast was made according to the size and shape of the flap needed for the damage and then this size was marked on the dilated flap. Modification of the size was made on the basis of blood supply until satisfactory design was achieved, the scar was excised and flap transferred there after. Different designs were made on different locations and emphasis was laid on the minimal number of cuts, which should be made on the unconspicuous locations along the cleavage lines. Results In the 50 cases we treated, the flaps survived and no disfigurement resulted. In the 28 follow-up cases, the flaps show normal color and good texture, with only slight scar proliferation. Conclusion Dilated flaps can be satisfactorily applied to the repair of facial scars.