应用扩张后的胸三角皮瓣修复颜面部大面积瘢痕

目的 探讨颜面部大面积瘢痕的修复方法.方法 对12例患者均采用在胸三角皮瓣下置入1个扩张器,切口选择在锁骨下,术中结扎颈横动脉颈段皮支、胸肩峰动脉皮支,以加强延迟效果,慎勿损伤胸廓内动脉穿支.胸三角皮瓣预扩张充分后,将面部瘢痕切除、松解挛缩,使眼、鼻、口等器官均恢复正常解剖位置,据缺损大小设计皮瓣,以胸侧端为蒂.术中将面部部分瘢痕瓣翻转与胸三角皮瓣带部对合缝合以封闭蒂部创面.3周后将皮瓣延迟,再1周后断蒂修复颏部创面.结果 12例应用扩张后的胸三角皮瓣修复单侧或双侧颜面部大面积瘢痕,术后效果满意.结论 扩张后的胸三角皮瓣是修复颜面部大面积瘢痕的可取方法.

Application of deltopectoral skin flap in the repair of extensive facial wound secondary to massive scar re-vision

Objective To explore the technique of massive facial scar revision. Methods All 12 patients in the group were treated with expanded deltopectoral skin flap. In the primary surgery, expander was implanted underneath deltopectoral flap region through an incision inferior to the clavi-cle. The skin perforators of transverse cervical artery and thoracoacromial artery were ligated during surgery, and the internal thoracic artery was carefully preserved. After the deltopectoral skin flap was fully expanded, the second surgery was performed and the facial scar was released and the normal ana-tomic position of eyes, nose and month was restored. The deltopectoral skin flap was planed according to the size of the defect. The excised facial scar was converted to the flap pedicle and a hinge-like con-nection was formed. The flap was delayed and three weeks after the second surgery, the pedicle was divided. The flap from the pedicle was applied for the mental region scar revision. Results Unilateral or bilateral dehopectoral skin flaps were employed for the repair of extensive facial scar in 12 patients. Satisfactory results were achieved in all these patients. Conclusion Expanded deltopectoral skin flap is a good technique for the repair of extensive facial scar.