中华整形外科杂志
中華整形外科雜誌
중화정형외과잡지
CHINESE JOURNAL OF PLASTIC SURGERY
2015年
1期
5-10
,共6页
王春梅%杨思奋%范金财%任家骠%徐伟%许开元%郭静苹%梅劲%高建华
王春梅%楊思奮%範金財%任傢驃%徐偉%許開元%郭靜蘋%梅勁%高建華
왕춘매%양사강%범금재%임가표%서위%허개원%곽정평%매경%고건화
软组织扩张术%穿支皮瓣%瘢痕
軟組織擴張術%穿支皮瓣%瘢痕
연조직확장술%천지피판%반흔
Soft tissue expansion%Perforator flaps%Cicatrix
目的 探讨一种将扩张皮瓣、穿支皮瓣与超薄皮瓣技术相结合的扩张预制超薄穿支皮瓣,在面颈部广泛性瘢痕治疗中的效果.方法 一期术前应用多排螺旋CT(MDCT)、多普勒超声血流探测仪定位穿支血管的部位及走行,于真皮下血管网以下为分离层次埋置扩张器,二期以穿支血管为蒂,设计扩张超薄穿支皮瓣,修复面颈部大面积瘢痕畸形及皮肤缺损.结果2005至2013年对26例面颈部广泛性瘢痕患者以扩张超薄穿支皮瓣修复,包括颈肩背皮瓣9例、颈胸皮瓣5例、面颈部皮瓣12例,结果 仅1例皮瓣远端坏死,余25例皮瓣均成活良好.其中颈肩背跨区供血扩张预制超薄穿支皮瓣的最大面积为35 cm×10 cm,蒂为8 cm×4 cm.术后随访6个月至3年,所见皮瓣厚度薄于一般扩张皮瓣,避免了二期皮瓣修薄,重建的面颈部轮廓结构分明,表情传递及五官功能良好.结论 扩张预制超薄穿支皮瓣在重塑局部轮廓、再现精细表情等方面呈现出明显的优势,对于面颈部广泛性瘢痕及大面积皮肤缺损修复是一种非常实用、安全的组织修复方法.
目的 探討一種將擴張皮瓣、穿支皮瓣與超薄皮瓣技術相結閤的擴張預製超薄穿支皮瓣,在麵頸部廣汎性瘢痕治療中的效果.方法 一期術前應用多排螺鏇CT(MDCT)、多普勒超聲血流探測儀定位穿支血管的部位及走行,于真皮下血管網以下為分離層次埋置擴張器,二期以穿支血管為蒂,設計擴張超薄穿支皮瓣,脩複麵頸部大麵積瘢痕畸形及皮膚缺損.結果2005至2013年對26例麵頸部廣汎性瘢痕患者以擴張超薄穿支皮瓣脩複,包括頸肩揹皮瓣9例、頸胸皮瓣5例、麵頸部皮瓣12例,結果 僅1例皮瓣遠耑壞死,餘25例皮瓣均成活良好.其中頸肩揹跨區供血擴張預製超薄穿支皮瓣的最大麵積為35 cm×10 cm,蒂為8 cm×4 cm.術後隨訪6箇月至3年,所見皮瓣厚度薄于一般擴張皮瓣,避免瞭二期皮瓣脩薄,重建的麵頸部輪廓結構分明,錶情傳遞及五官功能良好.結論 擴張預製超薄穿支皮瓣在重塑跼部輪廓、再現精細錶情等方麵呈現齣明顯的優勢,對于麵頸部廣汎性瘢痕及大麵積皮膚缺損脩複是一種非常實用、安全的組織脩複方法.
목적 탐토일충장확장피판、천지피판여초박피판기술상결합적확장예제초박천지피판,재면경부엄범성반흔치료중적효과.방법 일기술전응용다배라선CT(MDCT)、다보륵초성혈류탐측의정위천지혈관적부위급주행,우진피하혈관망이하위분리층차매치확장기,이기이천지혈관위체,설계확장초박천지피판,수복면경부대면적반흔기형급피부결손.결과2005지2013년대26례면경부엄범성반흔환자이확장초박천지피판수복,포괄경견배피판9례、경흉피판5례、면경부피판12례,결과 부1례피판원단배사,여25례피판균성활량호.기중경견배과구공혈확장예제초박천지피판적최대면적위35 cm×10 cm,체위8 cm×4 cm.술후수방6개월지3년,소견피판후도박우일반확장피판,피면료이기피판수박,중건적면경부륜곽결구분명,표정전체급오관공능량호.결론 확장예제초박천지피판재중소국부륜곽、재현정세표정등방면정현출명현적우세,대우면경부엄범성반흔급대면적피부결손수복시일충비상실용、안전적조직수복방법.
Objective To explore a combined application of tissue expansion,perforator flaps and super-thin flaps in reconstruction of extensive face and neck scars.Methods In the first stage,the position and course of the perforators were confirmed with the multi-detector computed tomography (MDCT) and color Doppler ultrasound.The expanders were implanted between subdermal vascular plexus and superficial fascia.In the second stage,the expanded super-thin perforator flaps were transferred to resurface the extensive defects and deformities in the face and neck.Results 26 cases with extensive facial and cervical scars were included in this study.Except for one case with necrosis at the distal end,the other 25 flaps survived completely.The maximum flap size was 35 cm × 10 cm with a pedicle of 8 cm × 4 cm.Long-term follow-up showed that this combined application provided thinner flap than the conventional pre-expanded flap,thus avoiding secondary flap debulking and revisions.All the patients got improvement in contours,facial features and emotional expression.Conclusions The combined application of tissue expansion,perforator flaps and super-thin flaps is a practical method which has advantages in feature recontouring and recovery of delicate emotions in reconstruction of extensive face and neck scars.
