CAJ | 학술논문

目的总结以双侧颞浅动静脉筋膜为蒂的额顶部扩张皮瓣修复男性颌颈部瘢痕的临床效果.方法 2005年7月至2009年6月,应用双蒂颞浅动静脉筋膜轴型皮瓣为13例颌颈部瘢痕男性患者(年龄21～38岁,平均27岁)进行修复治疗.瘢痕面积14 cm×5 cm至32 cm×15 cm.术前应用超声多普勒血流测定仪探测出颞浅动脉及其额、顶分支的位置和走行方向,并选择适当的扩张器备用.Ⅰ期手术:发际缘内正中矢状切口,在额肌及帽状筋膜下进行广泛剥离,形成容纳扩张器的腔隙;置入选定的扩张器.术后1～2周开始向扩张器内注水,间隔3～5d注水1次,注水量与扩张器容量之比为(1.5～3.5):1.Ⅱ期手术:切除颌颈部瘢痕组织,充分松解挛缩,确定瘢痕切除后受区面积;设计以双侧颞浅动静脉为蒂的扩张皮瓣,包括额部皮肤和发际缘头皮,取出扩张器,形成双蒂颞浅动静脉筋膜轴型皮瓣,皮瓣的大小为25 cm × 6 cm至32 cm × 9 cm;将分离好的双蒂颞浅动静脉筋膜轴型皮瓣转移修复创面,供瓣区直接拉拢缝合,形成新的发际线.Ⅲ期手术:Ⅱ期手术后3周,进行皮瓣断蒂和蒂部修整.结果各期手术顺利.扩张器共注水420-800 ml,平均660 ml;扩张时间3～5个月,平均4个月.皮瓣转移后全部成活,供瓣区均可直接拉拢缝合;颌颈部瘢痕完全切除,重建的胡须自然美观.结论双蒂颞浅动静脉筋膜轴型扩张皮瓣用于成年男性颌颈部瘢痕修复效果良好,可同时完成胡须重建,修复后面部形态美观.
목적 총결이쌍측섭천동정맥근막위체적액정부확장피판수복남성합경부반흔적림상효과.방법 2005년7월지2009년6월,응용쌍체섭천동정맥근막축형피판위13례합경부반흔남성환자(년령21～38세,평균27세)진행수복치료.반흔면적14 cm×5 cm지32 cm×15 cm.술전응용초성다보륵혈류측정의탐측출섭천동맥급기액、정분지적위치화주행방향,병선택괄당적확장기비용.Ⅰ기수술:발제연내정중시상절구,재액기급모상근막하진행엄범박리,형성용납확장기적강극;치입선정적확장기.술후1～2주개시향확장기내주수,간격3～5d주수1차,주수량여확장기용량지비위(1.5～3.5):1.Ⅱ기수술:절제합경부반흔조직,충분송해련축,학정반흔절제후수구면적;설계이쌍측섭천동정맥위체적확장피판,포괄액부피부화발제연두피,취출확장기,형성쌍체섭천동정맥근막축형피판,피판적대소위25 cm × 6 cm지32 cm × 9 cm;장분리호적쌍체섭천동정맥근막축형피판전이수복창면,공판구직접랍롱봉합,형성신적발제선.Ⅲ기수술:Ⅱ기수술후3주,진행피판단체화체부수정.결과 각기수술순리.확장기공주수420-800 ml,평균660 ml;확장시간3～5개월,평균4개월.피판전이후전부성활,공판구균가직접랍롱봉합;합경부반흔완전절제,중건적호수자연미관.결론 쌍체섭천동정맥근막축형확장피판용우성년남성합경부반흔수복효과량호,가동시완성호수중건,수복후면부형태미관.
Objective To explore the clinical efficacy of using forehead expansive skin flap doublepedicled with superficial temporal vessels for repairing male cervicofacial scar. Methods From July 2005 to June 2009, 13 male patients with an average age of 27 years old (range; 21-38) were operated by the above method. The scar-repairing area was from 14 cm × 5 cm to 32 cm× 15 cm. The procedure was carried out in three stages. Firstly, ultrasound Doppler was used to detect and mark the location and orientation of superficial temporal artery. A proper cavity was created under the forehead muscle and then the appropriate expander embedded through the scalp incision. The expander was expanded first by injecting normal saline at 1 or 2 weeks post-operation. After that, the injection was repeated by 3 or 5 days. The volume ratio of injection to expander was (1. 5 - 3. 5) : 1. Secondly the forehead expansive skin flap was designed with proper hair follicle scalp pedicled by bilateral superficial temporal artery when the expansion was completed. After removal of the expander, the rectangle expansive skin flap with hair follicle scalp was transferred through the double pedicle. The cervicofacial scar was excised according to the size of the transferred expansive skin flap (25 cm ×6 cm to 32 cm ×9 cm). And the flap was adjusted with hair follicle scalp to the middle of the chin area in order to obtain the normal beard appearance. Donor site were closed directly. Thirdly, the pedicle skin flap were cut and restored after one month. Results The volume expanded for each expander ranged from 420 to 800 ml (mean: 660). The average expansion time was 4 months (range: 3 - 5 ). All flaps survived well. Donor site were closed directly. Both chin and beard looked normal. Conclusions Repairing hypertrophic scar and reconstructing beard in cervicofacial area with forehead expansive skin flap pedicled by bilateral superficial temporal artery is a valuable and safe method.The donor site is scarless. And the reconstructed chin and beard are normal both functionally and aesthetically.