面颊部扩张皮瓣的设计和转移

目的探讨利用扩张皮瓣修复面颊不同部位皮肤缺损的扩张皮瓣设计。方法269例面颊部血管瘤、瘢痕、色素痣患者,依不同的皮肤缺损位置,在邻近部位放置大小适度的1~3个50~400ml容积的扩张器,扩张充分后采用推进皮瓣法、旋转推进皮瓣法和易位皮瓣法修复。结果269例中共形成305个扩张皮瓣,利用推进皮瓣121个,旋转推进皮瓣145个,易位皮瓣39个;共出现并发症52例,分别为扩张皮瓣远端血运障碍、血肿形成、感染、注水壶渗漏、扩张器外露、睑外翻和包囊挛缩,这些并发症基本未影响最终的手术效果,术后面颊部形态正常。结论我们提出的扩张皮瓣的设计和转移原则,对于面颊部的皮肤缺损组织扩张术治疗有非常重要的参考价值。

The design and transposition principles of expanded flap for treatment of cheek skin-soft tissue defect

OBJECTIVE: To explore an ideal method for repairing the skin-soft tissue defects according to the different anatomical units of cheek, and find reasonable design principles to transfer the expanded flaps. METHODS: According to the location of the defect, we placed 1-3 appropriate expanders nearby, when the flap expanded enough we adoped advanced skin flaps, rotation-advanced skin flaps or transposition skin flaps to repair the defect. In this group of 269 cases, the defects were secondary to hemangioma, various scars, nevus or nevus excision. RESULTS: In all 269 cheek defects, 305 expanded flaps were developed which included 145 rotation-advanced flaps, 121 advanced skin flaps and 39 transposition skin flaps. 52 of them generated complications, including blood circulation disorder of the distal part of flaps, hematoma, infection, injection, lower eyelid ectropion, expander extrusion and capsule contracture. Mostly, these complications didn't affect the final results. CONCLUSIONS: The principles presented in this article are the guidlines to treate the skin-soft tissue defect of check with tissue expansion. The satisfied results come from the reasonable flap designs.