扩张后胸三角皮瓣修复面颈部大面积瘢痕

目的:探讨胸三角皮瓣预扩张后,带蒂转移修复面颈部大面积瘢痕的治疗效果。方法:根据面颈部瘢痕范围,采用单侧或双侧胸三角皮瓣预扩张,选用500～600ml扩张器置入胸三角区,经2～4个月快速注水,注水总量可达1200～1800ml,获得足够皮肤后先行扩张皮瓣延迟术,2周后再切除面颈部瘢痕,创面应用扩张后胸三角皮瓣转移覆盖,供区直接拉拢缝合,待转移皮瓣夹管训练时间大于1h后断蒂,利用蒂部皮瓣来修复剩余瘢痕切除松解后的创面。结果:本组19例面颈部大面积瘢痕患者,共计26个胸三角皮瓣,1个皮瓣远端局部血运障碍,余皮瓣术后均成活好,皮瓣色泽、厚度、质地与周围皮肤相近,解决了瘢痕导致的组织畸形,患者及家属对总体效果满意。结论:扩张后胸三角皮瓣是修复面颈部大面积瘢痕的好方法。

Expanded delto-pectoral skin flap for treatment of facial and cervical massive scars

Objective To investigate the application of expanded deltopectoral flaps for treatment of large size of facial and cervical scars. Methods From February 2009 to October 2012 , the experiment of implanting kidney-shaped expanders with volume of 500-600ml in 19 cases of patients in this research have been implemented.The facial and cervical scars were corrected with unilateral expanded dehopectoral flaps and bilateral expanded dehopectoral flaps.Then,the skin was inflated by fast expansion model.Plenty of skin was obtained after 2 to 4 months injection of steriled water leading to 1200N1800ml volume of expanding space, following the implanting expanders.First at all,the flaps were prefabricated for 2 weeks.Then the facial and cervial scars were removed.The expanded deltopectoral flaps were used for repairing the surface of wound.After the skin flap pedicle division 7N10 days later,the skin flap pedicle was employed into restoring other surface of wound produced by removing residual scars. Results All the 26 flaps were survived.25 out of 26 flaps survived well.One flaps had disturbance of blood supply.Most transfer flaps had good blood supply, and the color and texture of the flaps matched the recipient place well.All operations had achieved satisfactory functional and aesthetic results. Conclusions Expanded dehopectoral flap is very suitable for large size of cervical eicatrieial contracture.