用扩张后超薄胸三角皮瓣修复颌面部较大面积瘢痕.doc

用扩张后超薄胸三角皮瓣修复颌面部较大面积瘢痕[摘要]目的：研究用胸三角皮瓣作面部大块瘢痕切除后创面的美容修复技术。方法：选择17例面部瘢痕患者，在19个胸三角区作皮肤扩张术，2个月后手术延迟预制定形皮瓣，最后将皮瓣作超薄处理并移植到面部。结果：19个胸三角皮瓣移植后全部成活。4个月以后随防显示，皮瓣色泽和质地与受区皮肤匹配良好，皮瓣组织质地柔软有弹性，局部无臃肿。皮肤感觉恢复快。结论：胸三角区扩张后皮瓣用于修复面部大块瘢痕安全可行，用延迟法作定形预制和超薄处理后，可获得理想的功能恢复和美学效果。 [关键词]组织扩张术；超薄皮瓣；胸三角皮瓣；皮瓣延迟术 [中图分类号]R622[文献标识码]A[文章编号]1008-6455（2007）10-1353-03 Expanded delto-pectoral ultra-thin flaps for aesthetic repair of large cicatrix inface LI Jiang1,LIU Guo2,CHEN Cen-fu1,YU Ren-yi1,WANG Ke-hua1,GUO Xiao-ping1 (1.Department of Plastic Aesthetic Surgery,General Hospital of Jinan Military Region, Jinan 250031,Shandong,China) Abstract： ObjectiveTo develop a method for aesthetic repair of large cicatrix in the face. MethodsSeventeen cases of patients with large cicatrix in the face were chosen in this study. nineteen large volume expanders were inserted into the subcutaneous pockets in the delto-pectoral zone and were inflated by fast expansion model. Two months later, the flaps were prefabricated, thinned and transplanted. After scars were resected, all the wounds were repaired.ResultsAll of the nineteen flaps were survived completely and the wounds healed well after transplantation. The long term follow up results show that the color and texture of the flaps match the recipient place well without swelling. The superficial and deep sensation recovered very fast.ConclusionIt is safe, practical and effective that the delto-pectoral flaps were used to repair large scar in the face. After the shaped flaps were prefabricated and thinned, ideal function and aesthetic effects could be achieved. Key words: tissue expansion; ultra-thin flap; delto-pectoral flap; flap delay 皮肤扩张术是颌面部瘢痕常用的修复方法[1-2]，当瘢痕面积较大时，局部皮肤扩张法或局部皮肤重复扩张法不能取得理想修复效果，但用胸三角区扩张后皮瓣带蒂转移可以一次性修复较大面积的颌面部瘢痕[3-4]。为了解决常规扩张后胸三角皮瓣移植的局部臃肿问题，我们采用了皮瓣超薄处理技术，以提高胸三角皮瓣移植后颌面部的美学质量。 1病例选择 面部瘢痕患者17例，其中男性9例，女性4例，年龄16～47岁。瘢痕范围主要分布在眉水平线以下、双耳以前的颌面部、颌颈沟以上。瘢痕面积最小6cm×8cm，最大12cm×18cm。本组患者采用双侧胸三角区同时扩张2例，单侧扩张15例。共埋置19个软质扩张器，容量400～800ml。