颈横动脉颈段皮支皮瓣的临床应用

目的探讨颈前瘢痕及严重的颏胸黏连、胸前瘢痕癌等的治疗方法。方法颈横动脉起自甲状颈干后,向外行走于胸锁乳突肌、肩胛舌骨肌深面,皮支在胸锁乳突肌与肩胛舌骨肌交点处穿出,并营养锁骨上、下区及前胸区皮肤。本组46例患者,颈部瘢痕及严重的颏胸黏连45例,胸前瘢痕癌1例,均采用颈横动脉颈段皮支皮瓣转移修复。术中先将颈部瘢痕切除,充分松解挛缩后或将肿瘤切除后,在锁骨上、下及前胸区依创面大小,结合颈横动脉颈段皮支的应用解剖,设计皮瓣,转移到受区。如供区采用预扩张术,则供区创面可拉拢缝合。否则,供区需采用断层或全厚皮片移植修复。结果本组46例患者,11例为带蒂皮瓣转移,余均为岛状皮瓣转移,颏胸黏连完全纠正,术后效果满意。结论采用颈横动脉颈段皮支皮瓣修复颏胸黏连、胸前瘢痕癌等,手术可一次完成,无继发畸形,是目前较理想的治疗方法。     

颈横动脉颈段皮支岛状扩张皮瓣修复颈部瘢痕挛缩

目的探讨以颈横动脉颈段皮支岛状扩张的皮瓣修复颈部瘢痕挛缩的方法、效果及注意事项。方法对11例颈部瘢痕挛缩患者先行Ⅰ期颈横动脉颈段皮支供血范围内的皮肤软组织预扩张术,Ⅱ期采用以颈横动脉颈段皮支为蒂的扩张岛状皮瓣（切取的扩张皮瓣最大17．5cm×8．0cm）和扩张后任意型皮瓣转移相结合,修复颈部瘢痕切除、挛缩松解后形成的创面,其中3例供区直接缝合,8例供区使用皮片覆盖。结果11例皮瓣全部成活,术后6～18个月随访,颈部轮廓和颈部功能获得明显改善。结论扩张的颈横动脉颈段皮支岛状皮瓣具有取材范围较大,旋转容易,相对隐蔽,皮瓣厚度、色泽、质地与颈部接近等优点;是修复颈部瘢痕挛缩较理想的方法。     

颈横动脉颈段皮支皮瓣的临床应用

目的 探讨颈前瘢痕及严重的颏胸黏连、胸前瘢痕癌等的治疗方法。方法 颈横动脉起自甲状颈干后，向外行走于胸锁乳突肌、肩胛舌骨肌深面。皮支在胸锁乳突肌与肩胛舌骨肌交点处穿出，并营养锁骨上、下区及前胸区皮肤。本组46例患者，颈部瘢痕及严重的颏胸黏连45例，胸前瘢痕癌1例，均采用颈横动脉颈段皮支皮瓣转移修复。术中先将颈部瘢痕切除，充分松解挛缩后或将肿瘤切除后，在锁骨上、下及前胸区依创面大小，结合颈横动脉颈段皮支的应用解剖，设计皮瓣，转移到受区。如供区采用预扩张术，则供区创面可拉拢缝合。否则。供区需采用断层或全厚皮片移植修复。结果 本组46例患者，11例为带蒂皮瓣转移，余均为岛状皮瓣转移，颏胸黏连完全纠正，术后效果满意。结论 采用颈横动脉颈段皮支皮瓣修复颏胸黏连、胸前瘢痕癌等，手术可一次完成，无继发畸形，是目前较理想的治疗方法。     

扩张预构胸背动脉穿支皮瓣修复儿童颈部瘢痕

目的 探讨修复儿童颈部瘢痕挛缩畸形的理想方法.方法 一期手术于颈部瘢痕周围以及背阔肌表面埋置扩张器,完成扩张后二期行颈部瘢痕切除、挛缩松解,用颈部局部扩张皮瓣修复部分创面后,解剖扩张预构的胸背动脉穿支皮瓣移植修复剩余创面,不损伤胸背神经内外侧支和背阔肌,供区直接拉拢缝合.结果 2007年6月至2009年10月,于临床应用10例,所有皮瓣均成活,颈部瘢痕松解后的刨面均一次性修复.随访3～30个月,皮瓣随生长发育而增长,畸形矫正完全且未再继发,皮瓣不臃肿,颏颈胸部形态良好,颜色差异不明显.供区瘢痕较轻,功能无影响.结论 扩张预构的胸背动脉穿支皮瓣游离移植修复儿童颈部较大面积瘢痕挛缩畸形,是较为理想的方法.     

扩张预构胸背动脉穿支皮瓣修复儿童颈部瘢痕

目的 探讨修复儿童颈部瘢痕挛缩畸形的理想方法.方法 一期手术于颈部瘢痕周围以及背阔肌表面埋置扩张器,完成扩张后二期行颈部瘢痕切除、挛缩松解,用颈部局部扩张皮瓣修复部分创面后,解剖扩张预构的胸背动脉穿支皮瓣移植修复剩余创面,不损伤胸背神经内外侧支和背阔肌,供区直接拉拢缝合.结果 2007年6月至2009年10月,于临床应用10例,所有皮瓣均成活,颈部瘢痕松解后的刨面均一次性修复.随访3～30个月,皮瓣随生长发育而增长,畸形矫正完全且未再继发,皮瓣不臃肿,颏颈胸部形态良好,颜色差异不明显.供区瘢痕较轻,功能无影响.结论 扩张预构的胸背动脉穿支皮瓣游离移植修复儿童颈部较大面积瘢痕挛缩畸形,是较为理想的方法.     

扩张预构胸背动脉穿支皮瓣修复儿童颈部瘢痕

目的 探讨修复儿童颈部瘢痕挛缩畸形的理想方法.方法 一期手术于颈部瘢痕周围以及背阔肌表面埋置扩张器,完成扩张后二期行颈部瘢痕切除、挛缩松解,用颈部局部扩张皮瓣修复部分创面后,解剖扩张预构的胸背动脉穿支皮瓣移植修复剩余创面,不损伤胸背神经内外侧支和背阔肌,供区直接拉拢缝合.结果 2007年6月至2009年10月,于临床应用10例,所有皮瓣均成活,颈部瘢痕松解后的刨面均一次性修复.随访3～30个月,皮瓣随生长发育而增长,畸形矫正完全且未再继发,皮瓣不臃肿,颏颈胸部形态良好,颜色差异不明显.供区瘢痕较轻,功能无影响.结论 扩张预构的胸背动脉穿支皮瓣游离移植修复儿童颈部较大面积瘢痕挛缩畸形,是较为理想的方法.     

预扩张的颈浅动脉皮瓣移位修复颈部瘢痕挛缩

目的为了减少颈浅动脉皮瓣移位修复颈部创面后的并发症，设计了预扩张皮瓣的方法，观察其临床效果。方法１９９５年３月～１９９７年１０月，对１２例颈部瘢痕挛缩畸形患者，先行颈浅动脉皮瓣供区预扩张术，二期行预扩张皮瓣移位修复颈部瘢痕切除后创面，其中颌颈粘连９例，下唇颌颈粘连３例。预扩张皮瓣最大为３５ｃｍ×１４ｃｍ，最小１６ｃｍ×７ｃｍ。结果术后１例皮瓣远端３ｃｍ×２ｃｍ坏死，植皮后创面愈合。其余１１例皮瓣完全成活。随访６个月～３年，所有患者颈部活动明显改善，颌颈角生理角度恢复，皮瓣色泽正常，外观不臃肿，未见继发挛缩。结论颈浅动脉皮瓣预扩张后移位修复颈部瘢痕挛缩畸形是较理想的一种方法。     

颈肩峰区跨区供血轴型扩张皮瓣修复颈部瘢痕挛缩

目的 探讨颈肩峰区跨区供血轴型扩张皮瓣的解剖学特征及应用于修复颈部瘢痕挛缩的临床效果.方法 应用颈横动脉分支和胸肩峰动脉吻合支跨区供血,形成前界为锁骨、后界为肩胛岗、外界为肩峰的颈肩峰区的扩张皮瓣,以颈侧为蒂转移修复较大面积的颈部软组织缺损.结果 15例患者的19个颈肩峰扩张皮瓣(面积最大为23 cm× 16 cm)全部成活,颈部畸形矫正良好.结论 颈肩峰区跨区供血的吻合支丰富,于深筋膜浅层进行扩张后皮下脂肪层及皮肤较薄,可以形成较大面积的扩张皮瓣,以颈横动脉颈段皮支为轴型血管,转移修复颈部较严重的瘢痕挛缩畸形,是一个良好的手术方法.     

颈肩反流轴型皮瓣修复颈胸部瘢痕切除后创面

目的：探讨修复颈胸部瘢痕切除术后创面的较好方法。方法：应用颈肩反流轴型皮瓣对26例颈胸部瘢痕切除术后创面进行修复。结果：26例瘢痕切除术后创面均得到一期修复,所修复创面的皮肤颜色和质地与周围皮肤一致,供皮瓣区术后瘢痕不明显。结论：该方法对于修复颈胸部一定范围内的瘢痕切除后创面是一种简单易行的好方法。     

应用超长扩张跨区供血的颈肩轴型皮瓣修复颈胸部瘢痕挛缩

目的：探讨获得较大面积的颈肩轴型皮瓣的可行性，为烧伤后大面积颈胸部瘢痕挛缩畸形提供理想的修复材料。方法：应用软组织扩张技术增加皮瓣的有效面积，设计以颈横动脉及其分支供血的对侧颈肩皮瓣修复颈胸部瘢痕挛缩。结果；临床应用8例，7例皮瓣完全成活。其中1例因超长扩张皮瓣远端出现血运障碍而效果欠佳。结论：由于颈肩背部血供的交叉性及丰富的吻合支存在，即使皮瓣的面积增大并逆主轴血管方向使用，仍能成活良好。     

应用巨型扩张的斜方肌肌皮瓣修复儿童颈部重度瘢痕挛缩畸形

目的探讨一种安全而有效地修复儿童颈部重度瘢痕挛缩畸形的手术方法。方法将以颈横动脉主干及降支为蒂的扩张斜方肌肌皮瓣转移至颈部，修复儿童颈部瘢痕挛缩畸形，背部供区直接拉拢缝合。结果临床应用于10例患儿，1例患儿由于二期手术肌皮瓣超长转移达颈部对侧耳下，术后肌皮瓣远端部分坏死，其余9例挛缩畸形矫正较为彻底，获得满意效果。结论在保证肌皮瓣血供的基础上，本肌皮瓣适宜修复儿童颈部重度瘢痕挛缩畸形。     

以颈横动脉为蒂的颈肩背反流轴型皮瓣

对２６例５２侧尸体进行了解剖学观察，结果证明，颈横动脉的血流可经吻合支反向灌入旋肩胛动脉及肋间后动脉，足以滋养在颈肩背区形成的轴型皮瓣。临床用以修复颈部瘢痕挛缩畸形２０例，其中１例应用双侧颈肩背皮瓣一次手术修复。除４例皮瓣的尖端发生血运障碍外，余均全部成活。     

以颈横动脉为蒂的颈肩背反流轴型皮瓣

对26例52侧尸体进行了解剖学观察,结果证明,颈横动脉的血流可经吻合支反向灌入旋肩胛动脉及肋间后动脉,足以滋养在颈肩背区形成的轴型皮瓣。临床用以修复颈部瘢痕挛缩畸形20例,其中1例应用双侧颈肩背皮瓣一次手术修复。除4例皮瓣的尖端发生血运障碍外,余均全部成活。     

应用颈深筋膜组织瓣重塑儿童颈部重度瘢痕挛缩矫治后颏突颌颈角

目的:观察矫治儿童颈部重度瘢痕挛缩植皮术中应用颈深筋膜组织瓣重塑颏突、颌颈角的治疗效果。方法:在局部肿胀麻醉和全麻下,充分松解颈部瘢痕挛缩,设计应用颈深筋膜组织瓣重塑颏突、颌颈角,然后移植中厚皮矫治儿童颈部重度瘢痕挛缩。结果:本组11例患儿术后下颏外形良好,颌颈角明显。结论:矫治儿童颈部重度瘢痕挛缩植皮术中应用颈深筋膜组织瓣重塑颏突颌颈角的手术方法,效果良好。     

带腓肠浅动脉蒂的逆行岛状筋膜皮瓣临床应用

目的：探寻一种良好的修复小腿下段及足部软组织缺损的方法。方法：对１９例新鲜尸体小腿行腓动脉灌注、造影及显微解剖，观察腓肠浅动脉的走行、腓动脉肌间隔皮穿支在小腿远端分支的部位，及两者在小腿下段的吻合情况；以及通过该吻合血管的血流对小腿后方皮肤的供应情况。同时临床应用以腓肠浅动脉为蒂的逆行岛状筋膜皮瓣修复小腿下段及足部软组织缺损７例。结果：腓动脉肌间隔皮穿支在小腿下段与腓肠浅动脉及其周围血管网存在丰富的吻合，可为该皮瓣的存活提供可靠的血运保证。结论：该皮瓣血运可靠，切取简单安全，覆盖范围广，一期手术即可完成，可有效地修复小腿下段及足部软组织缺损。     

Trapezius musculocutaneous flap in severe shoulder and neck burn

Scarring of the neck produces problems with function and appearance. The highly mobile anterior neck with its thin skin cover is particularly prone to flexion contractures that can range from minimally restrictive to crippling mentosternal synechiae. The trapezius muscle is the basis for muscle and musculocutaneous flaps that are of great usefulness in reconstructing defects of the head and neck and the upper back specially when there are no other regional flaps available. Use of trapezius musculocutaneous flap in the treatment of cicatricial contracture deformity of neck results in satisfactory function and external appearance and is a good method for the repair of soft tissue defects of the neck with the advantage of invariable blood supply. There is no deformation in the donor region which is hidden posteriorly. Its blood supply is rich enough to avoid any local necrosis after transplantation. Up to the present time this flap has been used to cover defects following excision of tumors in the head and upper parts of neck. Use of the trapezius musculocutaneous flap in seven patients who suffered from severe scarring in anterior neck and shoulder due to burn during an 8-year period (1995-2003) is described with good results achieved.     

Postburn head and neck reconstruction in children with the fasciocutaneous supraclavicular artery island flap

Postburn deformities or scar contractures in the head and neck region of children represent a challenge with unique problems compared with the rest of the body. Fourteen children suffered from neck contractures following burns, and 4 children required reconstruction following panfacial burn deformities. The experience of late-phase secondary burn reconstruction in the head and neck region of 18 pediatric patients (age range, 9-17 years) with 22 fasciocutaneous supraclavicular island flaps, including 5 preexpanded flaps, is reported. Clinical follow-up was performed between 10 and 29 months postoperatively. High functional and esthetic requirements could be fulfilled in all patients. Flap complications occurred in 9%, with low donor site morbidity (9%). The fasciocutaneous supraclavicular artery island flap is reliable and safe for immediate or late resurfacing of facial defects and to release cervical contractures. Customized flap design with tissue expansion without the need for microsurgery allows extended indications and optimized skin utilization, while good texture and color match is generally difficult to achieve in the head and neck region of severely burned children.     

带蒂腓肠浅动脉岛状皮瓣修复小腿外伤性皮肤缺损

目的　为了寻找修复小腿下段及踝足部皮肤缺损较好的皮瓣。方法　对21例小腿行腓动脉插管美蓝灌注、造影、显微解剖，了解腓肠浅动脉走行。手术16例，小腿下段6例、足跟部7例、足背部1例、踝部2例，皮瓣完全成活。结果　腓肠浅动脉在小腿中上段穿出深筋膜与腓肠神经伴行并发出许多营养支，营养小腿2/3后侧皮肤。结论　该皮瓣解剖恒定、血供良好、手术简单，Ⅰ期完成手术。它是修复小腿下段、踝部、足部皮肤缺损较好的皮瓣。     

The extra-long artery-pedicled back fascia skin flap for treatment of cervical contractive scar.

Severe cervical scar contractive after burn is best repaired with a flap for the neck maximal function restoration. The trapezius myocutaneous flap is a common one to be used for this purpose. However, the traditional technique is usually not appreciated to transfer the flap to the opposite side of the neck in one stage. The delayed procedures are usually needed. In this paper, an extra-long back fascia flap pedicled with descending branch of transverse cervical artery was developed to restore the whole cervical contractive scar after burn in only one operation. With our experience of 25 patients, the flap was usually formed as large as 10-14 cm wide (18-20 cm in expanded cases) and 35-45 cm long, as twice long as that formed by the traditional technique, and easily reaching the opposite side of the neck. Finally, the flaps were successfully transferred to repair the full neck in only one-stage procedure after the cervical scars were excised, except for two cases with partial necrosis in the flap tip. But the wounds were closed with further advancing the flap in secondary operation. In the end all of the patients were completely repaired. The result indicates that the extra-long back fascia flap pedicled with descending branch of transverse cervical artery could be formed long enough to reach the opposite side of the neck and safely transferred to neck in one stage.     

带蒂腓肠浅动脉岛状皮瓣修复小腿外伤性皮肤缺损

目的　为了寻找修复小腿下段及踝足部皮肤缺损较好的皮瓣。方法　对 2 1例小腿行腓动脉插管美蓝灌注、造影、显微解剖 ,了解腓肠浅动脉走行。手术 16例 ,小腿下段 6例、足跟部 7例、足背部 1例、踝部 2例 ,皮瓣完全成活。结果　腓肠浅动脉在小腿中上段穿出深筋膜与腓肠神经伴行并发出许多营养支 ,营养小腿 2 / 3后侧皮肤。结论　该皮瓣解剖恒定、血供良好、手术简单 ,Ⅰ期完成手术。它是修复小腿下段、踝部、足部皮肤缺损较好的皮瓣