Hypercoagulability in microvascular breast reconstruction: an algorithmic approach for an underestimated situation

Despite appropriate surgical technique and follow-up, flap failures can be encountered for which no valid reason is evident. Current literature states that these unpredictable flap failures can be caused by unknown patient factors, such as undiagnosed hypercoagulability. Our approach and experience utilizing an algorithm to minimize unpredictable failures in microvascular breast reconstruction by predetermining hypercoagulation risk factors in preoperative patients is presented. A prospective assessment of microsurgical breast reconstruction candidates between October 2007 and December 2010 was conducted. Patients were questioned about their tendency toward hypercoagulation. A thrombophilia panel was requested for patients confirming any risk factors. Appropriate surgical planning was conducted according to results of the panel. Of the 60 patients thoroughly questioned about hypercoagulation tendency, 21 (35%) confirmed having prothrombotic tendency and were referred to the thrombophilia testing. The results indicated hypercoagulation in 9 (15%) patients. The primary reconstruction plan of utilizing free flaps was abandoned for these patients and pedicled flaps or implants were preferred for reconstruction. These percentages emphasize the value of questioning risk factors and testing for hypercoagulation in patients seeking microsurgical breast reconstruction. We believe that detailed preoperative questioning of risk factors and appropriate testing according to prothrombotic tendency is beneficial in minimizing unpredictable flap failures and increasing rates of success.     

血栓弹力图预测髋膝关节置换术后血液高凝状态的价值分析

目的分析血栓弹力图(thromboelastography,TEG)预测髋膝关节置换术后病人血液高凝状态的价值。方法前瞻性纳入2019年3月至2019年12月于重庆医科大学附属第一医院拟行髋膝关节置换的204例病人,分析病人围术期的反应时间(R值)、血块形成时间(K值)、血块形成速率(α角)、最大振幅(MA值)、凝血指数(CI)的变化,评估TEG在诊断高凝状态方面与常规凝血试验的差异性和一致性,分析术后血液高凝的危险因素。结果相对于常规凝血试验,TEG诊断高凝状态的阳性率更高(P<0.001),两者具有一定的相关性和一致性。R值与国际标准化比值(international normalized radio,INR)、血小板计数(platelet counts,PLT)呈负相关,与活化部分凝血酶原时间(activated partial thromboplastin time,APTT)呈正相关;K值与PLT呈负性相关;α角与纤维蛋白原(fibrinogen,FIB)、PLT呈正相关;MA值与FIB、PLT呈正相关;CI值与FIB、PLT呈正相关,与D-二聚体(D-Dimer,D-D)呈负相关。术前高凝病人术后第1、3、5天的血液高凝发生率明显高于术前凝血功能正常者,差异均有统计学意义(P均<0.05)。根据术后第5天TEG诊断的凝血状态,年龄≥65岁[OR=8.938,95%CI(3.917,20.397),P<0.001]、围术期输血[OR=12.379,95%CI(5.304,28.893),P<0.001]是髋膝关节置换术后血液高凝的独立危险因素。结论TEG是预测术后高凝的有效指标,对于指导髋膝关节置换围术期个体化抗凝具有重要意义。     

Reducing Opposed Multilobed Flaps Results in Fewer Complications Than Traditional Repair Techniques When Closing Medium-Sized Defects on the Leg after Excision of Skin Tumor

BACKGROUND: The reducing opposed multilobed (ROM) flap involves a series of transpositions effected cephalic and caudal to the primary defect, sequentially mobilized toward and then into the primary defect. OBJECTIVE: To compare the ROM flap with other techniques to close defects below the knee after excision of skin tumor. METHOD: This retrospective study compares 140 defects closed with a ROM flap with 85 defects closed with traditional techniques. RESULTS: A total of 225 defects between 11 and 44 mm in diameter were excised over 3 years from July 1, 2002. There were 140 defects closed by ROM flap and 85 non-ROM closures including 29 "O-to-Z" flaps and 12 bilateral transposition flaps. A total of 111 squamous cell carcinomas, 64 basal cell carcinomas, and 11 melanoma were excised. ROM flap closures developed 20 complications (14.3%): 13 infections, 5 partial dehiscence, and 2 partial end flap necrosis. Non-ROM closures developed 27 complications (31.8%): 13 infections, 6 partial end flap necrosis, 4 partial dehiscence, 2 wound depression, 1 hemorrhage, and 1 persisting pain. Three ROM and 7 non-ROM cases suffered two complications. The total complication rate was significantly lower with ROM flaps (p=.003), including lower end flap necrosis incidence (p=.027). CONCLUSION: The ROM flap results in fewer complications than traditional techniques when closing defects 11 to 45 mm in size on the leg and foot. In particular, end flap necrosis incidence is lower with ROM flap closure.     

Coagulation modifications after laparoscopic and open cholecystectomy in a swine model

Background: The stress response to surgical trauma precipitates a state of transient hypercoagulation. Studies have demonstrated that laparoscopic surgery results in a diminished stress response compared to open surgery. The aim of this study was to determine the extent of postoperative hypercoagulability following laparoscopic cholecystectomy (LC) compared to open cholecystectomy (OC). Methods: Twenty-one pigs were randomly selected to undergo LC (N= 10) or OC (N= 11). Whole blood was collected preoperatively and on postoperative days (PODs) 1, 2, and 3 for determination of viscoelastic changes using a thromboelastography (TEG) coagulation analyzer. Four parameters were calculated from the TEG: R (reaction time), K (coagulation time), α (rate of clot formation), and MA (maximal amplitude). Antithrombin III (AT III) level was measured preoperatively and on POD 1. Results: After OC, three of four TEG parameters changed to reflect a state of hypercoagulation. Only MA values were significantly changed after LC. Comparison between OC and LC showed no difference in the TEG parameter. There was no significant change in AT III levels after LC or OC. Conclusions: OC results in postoperative hypercoagulation typically encountered in open abdominal surgery. Although there were no differences in TEG or AT III between the two groups, after the laparoscopic approach all but one TEG parameter remained unchanged, suggesting a diminished hypercoagulable state. By reducing postoperative hypercoagulation, laparoscopic surgery may reduce the risk of developing postoperative venous thrombosis.     

Combination of two local flaps for large defects after breast conserving surgery

PurposeOncoplastic surgery is a technique for wide excision of breast cancer without compromising the natural shape of the breast. We have combined two local flaps, referred to as a ‘combined local flap’, for large defects of the breast after a partial mastectomy.Patients and methodsTwenty-one patients with breast cancer underwent a partial mastectomy with immediate reconstruction when the surgical margin was positive and further excision was required or the tumor size was larger than the pre-operative evaluation. Reconstruction was consisted of a rotational local flap and a thoraco-epigastric flap (TEF), so-called a combined local flap. The cosmetic results were self-estimated after chemotherapy and radiotherapy according to a four-point scoring system.ResultsThe mean age of patients was 53.3 years and the mean tumor size was 2.2 cm. The mean excised breast volume was 133.8 mm³ and the percentage of excised volume was 20.4%. The cosmetic outcomes were judged as excellent, good, and fair in 11, 8, and 2 cases, respectively.ConclusionThe combined local flap, consisting of a rotational local flap and a TEF is a useful oncoplastic technique for large defects after breast-conserving surgery.     

Acral Fibrokeratoma of the Foot Treated with Excision and Trap Door Flap Closure: A Case Report

Acral fibrokeratoma is a relatively rare, benign lesion that is typically found on the fingers and toes but can also be found on the palms and soles. Several case reports have been published of this rare lesion, with only a few investigators describing lesions of the feet. The techniques of using skin from a portion of the mass to close the defect left from mass excision have been poorly reported. Our technique, which we have termed the “trap door flap,” has design similarities to the appearance and mechanics of a trap door. We present the case of a patient with a 7-year history of a slow-growing, soft tissue mass on the plantar and medial aspect of his left hallux. The mass was subsequently excised and closed with a local flap. The flap had healed uneventfully by 2 weeks postoperatively, and the patient denied any evidence of recurrence or pain at 12 months of follow-up.     

股上部直接皮动脉皮瓣的临床研究

目的 探讨切取股上部直接皮动脉皮瓣的解剖学依据并回顾其临床疗效.方法 对20侧灌注红色乳胶成人尸体下肢标本,进行解剖学观察;对其中2侧新鲜下肢标本,予股上部直接皮动脉灌注中华墨汁,观察皮瓣墨染范围.在50例股前外侧皮瓣切取手术中,对发现的股上部直接皮动脉进行追踪解剖.观察股上部直接皮动脉的出现率、动脉起始来源、走行并测量其管径.临床对42例皮肤软组织缺损的患者.采用股上都直接皮动脉皮瓣移植修复.结果 20侧灌注红色乳胶成人下肢标本,股上部直接皮动脉血管出现率为75.0%(15侧,15条).其中2侧新鲜下肢标本,股上部直接皮动脉皮瓣墨染面积分别为11.0 cm×18.0 cm、11.0 cm×19.0 cm.观察50例股前外侧皮瓣切取手术中,股上部直接皮动脉出现率为72.0%(36例,36条).出现的这51条股上部直接皮动脉中,血管起源类型有三种:起源于旋股外侧动脉(共29条,占56.9%);起源于股深动脉(共8条,占15.7%);起源于股动脉(共14条,占27.4%).股上部皮支血管从起点发出后,向大腿外下方于深、浅筋膜之间走行人皮肤,其穿出点多位于髂前上棘-髌骨外上缘连线中点上方3.0 cm、外侧2.5cm范围内,行程[(10.7±3.3)cm,(x)±s,下同].起始外径(2.7±0.2)mm,伴行静脉外径分别为(2.8±0.4)mm、(2.4±0.3)mm.本组42例股上部直接皮动脉皮瓣,皮瓣切取面积为6.0 cmx8.0cm～11.0cm×18.0 cm(游离皮瓣11例,带蒂皮瓣31例).术后3例皮瓣边缘部分坏死,经换药和皮片移植后愈合,其余皮瓣全部存活.结论 该皮瓣血供良好,不携带肌肉,切取容易,可携带股前外侧皮神经,既可带蒂转移,亦可作吻合血管的游离移植.     

Progressive neurological decline after partial spontaneous thrombosis of a Spetzler-Martin Grade 5 arteriovenous malformation in a patient with Leiden factor V mutation: management and outcome

The coexistence of a large intracranial arteriovenous malformation (AVM) and a hypercoagulation disorder is rare. The AVM puts the patient at risk for progressive neurological deficit, seizures, and, most importantly, intracranial hemorrhage The hypercoagulation disorder may result in an increased risk of stroke. The authors describe a 42-year-old man with a Spetzler-Martin Grade 5 AVM who experienced progressive neurological decline. He was subsequently discovered to have partial thrombosis of the AVM, deep cerebral and cortical venous thrombosis, and a hypercoagulation disorder. Hypercoagulation disorders causing neurological deficits are usually treated with anticoagulant medications; however, this approach was not thought to be safe in the presence of a large AVM. Therefore, the AVM nidus was surgically extirpated and a ventriculoperitoneal shunt was placed to treat the increased intracranial pressure caused by the cortical and deep cerebral venous thrombosis. Subsequently, lifelong oral anticoagulation was prescribed. The patient had a progressive neurological recovery and is now living independently at home. The occurrence of partial or complete spontaneous thrombosis of an AVM nidus should raise the possibility of an underlying hypercoagulation disorder.     

Mechanical properties of the extra‐fibrillar matrix of human annulus fibrosus are location and age dependent

The mechanical behavior of the annulus fibrosus (AF) of the intervertebral disc can be modeled as a mixture of fibers, extra‐fibrillar matrix (EFM), ions, and fluid. However, the properties of the EFM have not been measured directly. We measured mechanical properties of the human EFM at several locations, determined the effect of age and degeneration, and evaluated whether changes in EFM properties correspond to AF compositional changes. EFM mechanical properties were measured using a method that combines osmotic loading and confined compression. AF samples were dissected from several locations, and mechanical properties were correlated with age, degeneration, and composition. EFM modulus was found to range between 10 and 50 kPa, increasing nonlinearly with compression magnitude and being highest in the AF outer‐anterior region. EFM properties were not correlated with composition or degeneration. However, the EFM modulus, its relative contribution to tissue modulus, and model parameters were correlated with age. These measurements will result in more accurate predictions of deformations in the intervertebral disc. Additionally, parameters such as permeability and diffusivity used for biotransport analysis of glucose and other solutes depend on EFM deformation. Consequently, the accuracy of biotransport simulations will be greatly improved. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31:1725–1732, 2013     

Schwannoma of upper eyelid: A rare differential diagnosis of eyelid swellings

Schwannoma is a relatively rare benign tumour of peripheral nerve origin. The occurrence of Schwannoma in eyelid is extremely rare. As per our knowledge, only 11 such cases have been reported in the literature so far. We present a case of a 40-year-old man who presented to us with a 2-year history of slowly enlarging, painless mass in his left upper lid with resultant progressive ptosis. Ocular examination was suggestive of a firm, non-tender nodule of size 2 × 1.5 × 1 cm on the left upper lid. The mass was non-adherent to the skin or the underlying tissue. The eyelid skin and conjunctiva were indurated and signs of inflammation were present. The lateral part of eyelid showed presence of an ulcer and the lid function was severely hampered. Provisional clinical diagnosis was that of an eyelid malignancy. With this in mind, the medial part of the lid was excised and reconstructed using a tarso-conjunctival flap from the lower eyelid in conjunction with a skin graft. The histopathology and immunohistochemistry established the diagnosis of Schwannoma. We recommend that Schwannoma be considered in the differential diagnosis of well-circumscribed eyelid swellings.     

Effect of muscle flap denervation on flow hemodynamics: A new model for chronic in vivo studies

The purpose of this study was to evaluate microcirulatory dynamics following muscle flap denervation. A modification of standard cremaster muscle flap was used. Fifty male Sprague-Dawley rats were studied in two experimental groups of 25 rats each, as follows: Group I (control), after flap isolation, the nerovascular pedicle was left intact; group II (denervation), following muscle isolation a 1 cm segment of genitofemoral nerve was excised and denervated muscle was preserved in the medial border of rat hind limb. For chronic evaluation the cremaster was withdrawn from the leg and prepared for in vivo observations after days 1, 3, 7, and 14. The following measurements were taken: vessel diameters, red blood cell velocities, and number of perfused capillaries. In groupII a 15% iuncrease in artriolar diameter was observed. Throughout the entire 14 day period denervated flaps presented 27% more perfused capillaries. Flap denervation proved to increase capillary perfusion significantly (P < 0.05). The cremaster muscle tube-flap model introduced in this study allows for chronic observtion of the microcirculation. © 1994 Wiley-Liss, Inc.     

Biplanar Temple Lift for Lateral Brow Ptosis: Comparison with Uniplanar Dissection Technique

BACKGROUND: The amount of lift achievable in the temple region has been limited by traditional uniplanar dissection techniques. A biplanar temple-lifting technique (BTL), involving a biplanar dissection both deep and superficial to the superficial musculoaponeurotic system (SMAS) of the temporal region, is described. This study compares the amount of temporal lifting that can be achieved using a uniplanar dissection with that achieved using a biplanar dissection. METHODS: Thirty-seven patients underwent bilateral temple lifting. Deep dissection was performed on the surface of the deep temporalis fascia. The skin flap was pulled in a superolateral direction and the skin overlap at the wound edge was measured. A SMAS flap was then dissected beneath the dermis from the anterior wound edge to the temporal hairline. The SMAS flap was suspended superolaterally and fixated to the deep temporalis fascia. The skin flap was again pulled in a superolateral direction and the amount of skin overlap was measured and compared. RESULTS: The average potential temple skin that could be excised using the traditional dissection technique was 15.1 mm (range, 7-24 mm). The average temple skin that was excised using the biplanar dissection technique was 21.8 mm (range, 14-30 mm). The biplanar technique was shown to offer, on average, a 48% increase in lift relative to the skin-only approach. There were no cases of wound dehiscence, necrosis, or overcorrection. CONCLUSION: Using the BTL technique to create a temporal SMAS flap, dissected free from overlying dermis as well as from deep temporal fascia, provides a more secure suspension of the temporal flap and significantly greater temple lift than a uniplanar dissection. The deep layering absorbs the tension of the lift, allowing for tensionless skin closure, thus decreasing the potential for scarring, hair loss, and necrosis. The increased mobility and higher suspension of the temporal flap allows for more skin excision and therefore a more pleasing lateral brow height.     

Total excision and V-Y plasty technique in the anal area condyloma acuminatum

Condyloma acuminatum is located in the perianal region, anal canal, vagina and the perineum. It is caused by human papillomavirus types 6 and 11. A 18 year-old man was admitted to the clinic because of a perianal mass. On examination of the patient''s perianal area and inside the anal canal, a mass was found, which was nearly 8 × 8 cm in size. We could not obtain any information about venereal transmission. The mass was totally excised and the defect was reconstructed with a bilateral V-Y advancement flap. This technique has been used for sacrococcygeal, ischial and other defects but rarely used for condyloma acuminatum. We think that total excision and the use of the V-Y advancement flap technique is safe and has low morbidity in the treatment of condyloma acuminatum.     

A prospective,randomized comparison of thromboelastographic coagulation profile in patients receiving lactated Ringer's solution, 6% hetastarch in a balanced-saline vehicle,or 6% hetastarch in saline during major surgery

OBJECTIVES: To compare the effects of lactated Ringer's solution (LR), 6% hetastarch in a balanced-saline vehicle (HS-BS), and 6% hetastarch in normal saline (HS-NS) on coagulation using thromboelastography. DESIGN: Prospective, randomized double-blinded evaluation of previously published clinical trial. SETTING: Tertiary-care medical center. PARTICIPANTS: Patients undergoing elective noncardiac surgery with an anticipated blood loss >500 mL. A total of 90 patients were enrolled with 30 patients in each group. INTERVENTIONS: Patients received a standardized anesthetic. LR, HS-BS, and HS-NS were administered intraoperatively based on a fluid administration algorithm. Hemodynamic targets included maintenance of arterial blood pressure, heart rate, and urine output within a predefined range. MEASUREMENTS AND MAIN RESULTS: Thromboelastography variables for r time, k time, maximum amplitude, and alpha angle (mean +/- SD) were recorded at induction of anesthesia, at the end of surgery, and 24 hours postoperatively. Patients in the LR group showed a state of hypercoagulation at the end of surgery with reductions (p < 0.005) in r time (-3.8 +/- 6.7 mm) and k time (-1.7 +/- 2.5 mm). This state of hypercoagulation continued into the postoperative period. Patients in the HS-NS group showed a state of hypocoagulation with increases (p < 0.05) in r time (+6.2 +/- 8.5 mm) and k time (+1.7 +/- 3.9 mm) and a reduction in maximum amplitude (-8.0 +/- 9.8 mm) at the end of surgery. This state of hypocoagulation was reduced in the postoperative period. Patients in the HS-BS group showed no significant changes in coagulation status at end of surgery, with the smallest changes in r time (-0.3 +/- 4.1 mm), k time (+0.1 +/- 3.1 mm), maximum amplitude (-5.4 +/- 12.3 mm), and alpha angle (0.3 +/- 12.5 degrees ). CONCLUSION: LR-treated patients exhibited a hypercoagulative profile that persisted into the postoperative period. HS-BS administration was associated with a lesser change in the coagulation profile compared with HS-NS, which was associated with a hypocoagulative state.     

Clotting onset time may be a predictor of outcome in human brain injury: a pilot study

In this study we assess the clotting onset time (COT) in samples from a population of traumatic brain injury patients. The patients were randomized to standard treatment plus high dose antithrombin (AT group) or standard treatment alone (nonAT group), during the first 16 hours after hospital admission. Our aim was to study the two patient groups during the first 5 days after injury, to assess COT as a coagulation monitoring method compared to routine parameters (thrombin-antithrombin complex (TAT), D-dimer, and soluble fibrin), and to correlate COT to clinical parameters and outcome. Clotting onset time measurements are carried out using free oscillating rheometry, where the endpoint of coagulation onset is determined by a deviation from initial viscoelastic properties of an oscillating sample. Both patient groups initially showed hypercoagulation. In the AT group, a significant increase of COT (i.e., decrease in hypercoagulation), was already seen 16 hours after hospital admission, but not until day 3 in the non AT group. Routine coagulation tests were not able to discriminate AT patients from nonAT patients. Clotting onset time correlated significantly to soluble fibrin, D-dimer, TAT, and leukocyte count. Additionally, COT levels at hospital admission correlated to outcomes measured with the Glasgow Outcome Scale (GOS) after 3 months. These results indicate that COT may be a clinically relevant variable with prognostic value, able to monitor the degree of hypercoagulation over time.     

Experimental study of the influence of arterial trauma on dependent distal tissue survival

An experimental model was developed combining arterial trauma with island flap creation using the rat groin flap system. Flap arteries were subjected to crush/avulsion injuries with subsequent microvascular repair. A second series involved resection 4 hr after thrombosis of injured flap arteries and interpositional vein grafting to reestablish circulation. A single bolus of systemic heparin was administered to half of the animals from each series on a blinded, randomized basis. Arterial patency at 7 days correlated with flap survival. There was no case of partial flap loss. Patencies improved in the first series from 31% to 71% with heparin administration (P less than 0.05) and from 58% to 90% in the second (not significantly different). A third series involving immediate resection of traumatized vessel and vein graft replacement achieved a patency of 92% (without heparinization). These results support the value of replacement of all traumatized arterial tissue with vein grafts and indicate the efficacy of systemic heparin (in single bolus) for enhancing the likelihood of maintaining patency. Furthermore, it is suggested that the occurrence of a thrombogenic site in the arterial inflow to a region of dependent tissue does not lead to partial tissue loss, and thus thromboembolic events may not be responsible for this clinical phenomenon.     

Clexane and regional anesthesia. Contraindication or possible combination?

Results of the efficacy and safety analysis of low-molecular weight heparine clexane (sodium enoxaparine) in patients with urological diseases were adduced. Postoperative usage of clexane along with epidural anesthesy had prevented occurrence of hypercoagulation as well as epidural and spinal hematoma.     

D-dimer for diagnosis of periprosthetic joint infection: A meta-analysis

BackgroundThe D-dimer test is easily available to detect periprosthetic joint infection (PJI). This study aimed to estimate the diagnostic accuracy of the D-dimer test in PJI diagnosis and identify possible independent factors affecting the diagnostic value of this test.MethodsMEDLINE and EMBASE databases identified literature until February 2020 that utilized the D-dimer test for PJI diagnosis. The pooled sensitivity, specificity, area under the curve (AUC), diagnostic odds ratio (DOR), positive likelihood ratio (PLR), and negative likelihood ratio (NLR) were calculated to evaluate the diagnostic accuracy of the D-dimer test. Meta-regression and subgroup analyses were performed to assess potential heterogeneity.ResultsThe databases identified 243 records, and eight studies were included in the final analysis. The pooled sensitivity and specificity of the D-dimer test for PJI diagnosis were 0.78 (95% confidence interval [CI], 0.69–0.84) and 0.74 (95% CI, 0.85–0.99), respectively. The AUCs and DORs of the D-dimer test were 0.83 (95% CI, 0.79–0.86) and 10 (95% CI, 4–24), respectively. The PLR and NLR of the D-dimer test for PJI detection were 3.0 (95% CI, 1.9–4.8) and 0.30 (95% CI, 0.20–0.47), respectively. The results of the meta-regression and subgroup analyses indicated that studies that excluded patients with hypercoagulation disorder had higher sensitivity (0.85 vs 0.86) and specificity (0.83 vs 0.62). The sensitivity of the D-dimer test also improved in studies that excluded patients with inflammatory arthritis (0.81 vs 0.75).ConclusionThe D-dimer test is a practical method for PJI diagnosis, especially in patients without history of hypercoagulation disorder and inflammatory arthritis.     

应用局部皮瓣治疗仰趾畸形

目的:探讨烧、创伤后,足背瘢痕挛缩所致仰趾畸形的治疗。方法:术中将足背瘢痕切除,彻底松解挛缩,将弓弦状伸肌腱切除部分或切断,切除部分挛缩的跖趾关节背侧关节囊,使关节复位,克氏针外固定,在拇指内侧或小趾侧,以跖趾关节处为蒂设计逆行皮瓣,转移覆盖外露的跖趾关节,供区及瘢痕切除后创面行全厚或断层皮片修复。结果:本组7例,均采用逆行皮瓣修复,畸形完全纠正,无继发畸形。结论:应用拇指及小趾侧方逆行皮瓣转移,治疗仰趾畸形可达到满意效果。     

扩张后胸三角皮瓣修复面部良性肿瘤切除后创面

目的 探讨面部良性肿瘤切除后创面的修复方法.方法 根据患者面部良性肿瘤的面积,采用单侧或双侧胸三角皮瓣预扩张,在胸三角皮瓣下靠近肩部置入1个扩张器,切口选择在锁骨下.扩张完成后,先将面部良性肿瘤部分或全部切除,据缺损大小设计皮瓣.皮瓣应大于缺损面积10％～15％,蒂部可制成管状或应用良性肿瘤翻转与胸三角皮瓣蒂部形成铰链而封闭蒂部创面.3周后将皮瓣延迟,再1周后断蒂.结果 20例患者应用扩张后胸三角皮瓣带蒂转移修复面部良性肿瘤切除后创面,效果均满意.结论 扩张后胸三角皮瓣是修复较大面积面部良性肿瘤切除后创面的较好方法.