扩张后胸三角皮瓣在面颈部大面积瘢痕挛缩畸形整复中的应用

目的探讨应用扩张后胸三角皮瓣修复面颈部瘢痕挛缩畸形的效果。方法8例单双侧面颈部瘢痕挛缩畸形患者，采用同侧或者对侧胸三角区植入400-600ml柱形或肾形扩张器，经过2～3月注水（注水量600～800ml），获得足够皮肤后切除面颈部瘢痕，创面应用扩张后胸三角皮瓣转移修复，3～4周断蒂，利用蒂部皮瓣修复剩余瘢痕切除松解后创面。结果本组共计12个胸三角皮瓣，其中1例后期出现皮肤坏死、扩张器外露，但对手术效果影响不大。12个胸三角皮瓣转移术后10个存活好，2个皮瓣远端血运障碍，经过早期放血疗法、压迫疗法处理后血运恢复，均存活；1个皮瓣少许坏死，经过皮瓣“蠕动”手术方式、治疗后愈合。存活后皮瓣色泽、厚度、质地与周边皮肤相近，解决瘢痕挛缩导致的睑外翻、唇外翻、颏颈粘连畸形，患者及家属满意度高。结论面颈部大面积瘢痕整复中使用扩张后胸三角皮瓣是一种理想的修复手段。

Application of expanded delto-pectoral skin flap in repairing deformities of facial and cervical massive scars

To report the application of expanded delto-pectoral skin flaps for treatment of facial and cervical scars after burn.Eight patients with facial and cervical scars as a result of burn injury were repaired by using unilateral or bilateral delto-pectoral flaps.First at all,600-800ml volume expanders were inserted into the outside pockets in the delto-pectoral zone for two or three months.Then,the skin was inflated by fast expansion model.Total 12 skin flaps were obtained in these patients.After dilated,the flaps together with their pedicles were transplanted to repair faciocervical scars.10 out of 12 flaps survived well.Two flaps had disturbance of blood supply.However,their blood supply was recovered after proper treatments.One flap had a little necrosis that had little effect on operation.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.Transplantation of expanded delto-pectoral flaps may be an efficacious procedure for repairing massive facial and cervical scars.