中华医学美学美容杂志
中華醫學美學美容雜誌
중화의학미학미용잡지
CHINESE JOURNAL OF MEDICAL AESTHETICS AND COSMETOLOGY
2010年
2期
88-89
,共2页
斜颈%颈阔肌肌皮瓣%畸形
斜頸%頸闊肌肌皮瓣%畸形
사경%경활기기피판%기형
Torticollis%Flap%Deformity
目的 介绍一种安全、实用的重度肌性斜颈修复术.方法 以蹼状挛缩突出的胸锁乳突肌为轴,两端分别为胸锁乳突肌的乳突起点和下端锁骨头点,设计3瓣在内下、2瓣在外上的五瓣,每瓣臂长大致为轴长的一半.局部麻醉下切开皮瓣至颈阔肌下层,直视下锐性分离各肌皮瓣,慎勿使颈阔肌与皮肤脱离,松解蹼状皮肤,即可见已经变细且纤维化的胸锁乳突肌及挛缩的颈鞘、颈浅静脉.于肌肉中点完全切断胸锁乳突肌,两断端回缩,切断并结扎颈浅静脉,松解挛缩的颈鞘,显露出短缩的颈动脉、神经,将头尽量摆正,在注意保护动脉、神经的前提下,松解其周围牵拉的筋膜组织,止血后将肌皮瓣对位缝合覆盖外露的动脉、神经、肌肉组织,放置橡皮引流条包扎固定.结果 5例中有1例达到良,4例为中度.皮瓣均成活,效果满意.瘢痕不明显.结论 采用颈阔肌肌皮瓣五瓣Z成形术,可良好地纠正同侧肌性斜颈畸形,用颈阔肌覆盖外露的神经、血管,就地取材,既能防止术后肌皮瓣区粘连、局部凹陷畸形,又能确保皮瓣的血供.
目的 介紹一種安全、實用的重度肌性斜頸脩複術.方法 以蹼狀攣縮突齣的胸鎖乳突肌為軸,兩耑分彆為胸鎖乳突肌的乳突起點和下耑鎖骨頭點,設計3瓣在內下、2瓣在外上的五瓣,每瓣臂長大緻為軸長的一半.跼部痳醉下切開皮瓣至頸闊肌下層,直視下銳性分離各肌皮瓣,慎勿使頸闊肌與皮膚脫離,鬆解蹼狀皮膚,即可見已經變細且纖維化的胸鎖乳突肌及攣縮的頸鞘、頸淺靜脈.于肌肉中點完全切斷胸鎖乳突肌,兩斷耑迴縮,切斷併結扎頸淺靜脈,鬆解攣縮的頸鞘,顯露齣短縮的頸動脈、神經,將頭儘量襬正,在註意保護動脈、神經的前提下,鬆解其週圍牽拉的觔膜組織,止血後將肌皮瓣對位縫閤覆蓋外露的動脈、神經、肌肉組織,放置橡皮引流條包扎固定.結果 5例中有1例達到良,4例為中度.皮瓣均成活,效果滿意.瘢痕不明顯.結論 採用頸闊肌肌皮瓣五瓣Z成形術,可良好地糾正同側肌性斜頸畸形,用頸闊肌覆蓋外露的神經、血管,就地取材,既能防止術後肌皮瓣區粘連、跼部凹陷畸形,又能確保皮瓣的血供.
목적 개소일충안전、실용적중도기성사경수복술.방법 이복상련축돌출적흉쇄유돌기위축,량단분별위흉쇄유돌기적유돌기점화하단쇄골두점,설계3판재내하、2판재외상적오판,매판비장대치위축장적일반.국부마취하절개피판지경활기하층,직시하예성분리각기피판,신물사경활기여피부탈리,송해복상피부,즉가견이경변세차섬유화적흉쇄유돌기급련축적경초、경천정맥.우기육중점완전절단흉쇄유돌기,량단단회축,절단병결찰경천정맥,송해련축적경초,현로출단축적경동맥、신경,장두진량파정,재주의보호동맥、신경적전제하,송해기주위견랍적근막조직,지혈후장기피판대위봉합복개외로적동맥、신경、기육조직,방치상피인류조포찰고정.결과 5례중유1례체도량,4례위중도.피판균성활,효과만의.반흔불명현.결론 채용경활기기피판오판Z성형술,가량호지규정동측기성사경기형,용경활기복개외로적신경、혈관,취지취재,기능방지술후기피판구점련、국부요함기형,우능학보피판적혈공.
Objective To introduce a safe and practical approach for the treatment of severe muscular torticollis. Methods In an axis of the spasmodic sternocleidomastoid muscle, the author designed a five-valve flap with two valvae inside, which ended at the mastoid point and inferior clavicular part of sternocleidomastoid muscle, respectively. The arm length of each valve was approximately half of its axis. Each valve was separated bluntly in naked eyes in order not to detach the platysma myoides from the skin, and to release the webbed neck. Under the flap, the thinned and fibrosed sternocleidomastoid muscle and spasmodic neck sheath and superficial cervical vein were easily found. The sternocleidomastoid muscle was disconnected at the median point, and the two ends were retracted, the superficial cervical vein was cut and ligated, the neck sheath was released to uncover the spasmodic cervical artery and nerve. The head was right positioned, and then the surrounded fascial tissues were released under the protection of the arteries and veins. The flap was sutured to cover the arteries, veins and muscles. Results Reasonably good effect was achieved in one case and intermediate effects in other 4 cases. Surgical results were satisfactory. All the flaps were survival with insignificant scar formation. Conclusions Webbed skin deformity in the neck can be corrected by using five-valve plastic surgery of platysma myoides, which is able to cover the exposed nerves and vessels. This procedure prevents the adhesion of the operated area, ensures the blood supply of the distal portion of the flap, and also avoids the damage of other tissues in the flap area.
