CAJ | 학술논문

目的了解带双侧颞浅动、静脉额支筋膜蒂的额部轴型扩张皮瓣(下称额部双蒂轴型扩张皮瓣)修复下颌部瘢痕的可行性. 方法 2005年7月-2009年12月,笔者对南京军区福州总医院第一附属医院烧伤整形科收治的16例下颌部瘢痕患者,采用额部双蒂轴型扩张皮瓣进行修复.手术分3期进行:术前应用超声多普勒血流探测仪探测出颞浅动、静脉及其额、顶分支的位置和走行方向.Ⅰ期手术时,以颞浅动、静脉为蒂,在额肌下进行剥离,形成容纳扩张器的皮肤软组织腔隙,置人适当大小的扩张器.注水扩张结束后进行Ⅱ期手术,取出扩张器,切取额部双蒂轴型扩张皮瓣修复下颌部瘢痕,供瓣区直接拉拢缝合.Ⅲ期手术为皮瓣断蒂、蒂部修整及瘢痕修复术. 结果本组患者轴型皮瓣面积25 cm×6 cm～33 cm×16 cm,扩张时间3～5个月,平均3.6个月,其中10例联合应用颈部皮肤扩张术治疗,皮瓣均成活,伤口愈合.1例患者Ⅱ期手术后出现皮瓣远端部分回流障碍,经予解痉、促皮瓣静脉回流等综合处理后康复.供区创面愈合,发际无瘢痕性脱发,毛发生长正常.3例女性患者中,2例皮瓣未携带前发际处毛发;另1例下颌部术区携带前发际少量毛发,其与要求作络腮胡塑形的2例男性患者于出院1～3个月后行激光脱毛处理,效果较好.其他男性患者对术区须发不作特殊处理或自行用剃须刀塑形.16例患者均获6～24个月随访,皮瓣及胡须(女性患者除外)外形美观,无臃肿,色泽、质地较好,颈部活动功能明显改善. 结论额部双蒂轴型扩张皮瓣除可促进皮瓣的新生血管化、提供更大面积的薄型皮瓣外,剩余扩张皮肤可以直接缝合于发际缘,不需植皮,降低了供瓣区继发畸形的发生率.皮瓣携带部分毛发经旋转后可直接进行胡须重建,使男性患者外形更加美观.
목적 료해대쌍측섭천동、정맥액지근막체적액부축형확장피판(하칭액부쌍체축형확장피판)수복하합부반흔적가행성. 방법 2005년7월-2009년12월,필자대남경군구복주총의원제일부속의원소상정형과수치적16례하합부반흔환자,채용액부쌍체축형확장피판진행수복.수술분3기진행:술전응용초성다보륵혈류탐측의탐측출섭천동、정맥급기액、정분지적위치화주행방향.Ⅰ기수술시,이섭천동、정맥위체,재액기하진행박리,형성용납확장기적피부연조직강극,치인괄당대소적확장기.주수확장결속후진행Ⅱ기수술,취출확장기,절취액부쌍체축형확장피판수복하합부반흔,공판구직접랍롱봉합.Ⅲ기수술위피판단체、체부수정급반흔수복술. 결과본조환자축형피판면적25 cm×6 cm～33 cm×16 cm,확장시간3～5개월,평균3.6개월,기중10례연합응용경부피부확장술치료,피판균성활,상구유합.1례환자Ⅱ기수술후출현피판원단부분회류장애,경여해경、촉피판정맥회류등종합처리후강복.공구창면유합,발제무반흔성탈발,모발생장정상.3례녀성환자중,2례피판미휴대전발제처모발;령1례하합부술구휴대전발제소량모발,기여요구작락시호소형적2례남성환자우출원1～3개월후행격광탈모처리,효과교호.기타남성환자대술구수발불작특수처리혹자행용체수도소형.16례환자균획6～24개월수방,피판급호수(녀성환자제외)외형미관,무옹종,색택、질지교호,경부활동공능명현개선. 결론 액부쌍체축형확장피판제가촉진피판적신생혈관화、제공경대면적적박형피판외,잉여확장피부가이직접봉합우발제연,불수식피,강저료공판구계발기형적발생솔.피판휴대부분모발경선전후가직접진행호수중건,사남성환자외형경가미관.
Objective To study the feasibility of applying expanded forehead axial flaps with fascia pedicles carrying bilateral frontal branches of superficial temporal artery and vein(expanded forehead axial flap with double pedicels in brief, EFAF-DP) in repairing scars in submaxillary region. Methods Sixteen patients with mandibular scars hospitalized in Department of Burns and Plastic Surgery of the First Hospital Affiliated to Fuzhou General Hospital in Nanjing Military Area Command from July 2005 to December 2009 were repaired with EFAF-DP. The operation consisted of 3 stages. Before operation, the location and course of superficial temporal arteries and veins (STAV) and their frontal and parietal branches were identified with Ultrasonic Doppler blood flow detector. In stage Ⅰ , STAV were dissected from the frontalis muscle as a pedicle to form a skin soft tissue space to hold the dilator of a proper size. In stage Ⅱ , after gradual dilation by repeated filling with saline, the dilator was removed. EFAF-DP was dissected to repair mandibular scar. Donor site was closed with sutures. In stage Ⅲ , flap pedicles were divided and pruned. Results Flap sizes ranged from 25 cm ×6 cm to 33 cm × 16 cm. The duration of dilation was 3-5 months, with 3.6 months in average. Ten patients underwent the operation of EFAF-DP transplantation and cervical skin dilatation. All flaps survived with healing of wounds. Disorder of venous return at the distal end of one flap was seen after second stage surgery, and it was corrected after comprehensive treatment including relieving spasm and improving venous return. Donor site wounds healed with normally grown hair without cicatricial alopecia along the hairline. Few hairs grew around mandible in one female patient out of the three(no hair grew on flaps of other two patients). This female patient and two male patients requesting for beard plasty received laser depilation treatment 1 to 3 months after discharge, with good result. Other male patients received no special treatment for their beard, and they shaped their beard with shaver. Sixteen patients were followed up for 6 to 24 months, and the shape of the flaps and beard (excluding female patients) were satisfactory with good appearance, satisfactory skin color and texture. The mobility of neck was obviously improved. Conclusions EFAF-DP provides bigger areas of a thin flap besides promoting vascularization of new vessels of flap. Extra expanded skin can be directly sutured at the fringe of hairline, which makes skin grafting unnecessary, and decreases the incidence of secondary deformity in donor sites. Some hair carried by the flaps can be directly used for beard reconstruction after rotation to help the male patients have a better appearance.