颞浅筋膜预置耳后扩张皮瓣在面部较大面积创面修复中的应用

目的 探索颞浅筋膜预置耳后扩张皮瓣,在修复面部较大面积组织缺损中的应用.方法 自2007年,对10例较大面部浅表性组织缺损患者,采用颞浅筋膜预置耳后扩张皮瓣进行修复.Ⅰ期手术形成由颞浅动脉顶支供血的筋膜岛状瓣,预置于耳后乳突区皮下,同时在筋膜瓣下埋置皮肤扩张器.注水完成并保持3～5个月,动脉造影观察颞浅动脉分支在耳后的区分布.Ⅱ期手术取出扩张器,形成以颞浅动脉直接供血的耳后岛状皮瓣,经皮下隧道转移覆盖面部创面.结果 本组患者术后随访6～18个月.2例术后24h出现皮瓣远端静脉回流受阻,致浅表组织坏死,于2周内创面愈合.其余皮瓣存活良好.皮瓣切取最大面积7 cm×3.5 cm.结论 颞浅筋膜岛状瓣预置耳后扩张皮瓣,皮瓣薄,供皮区无需植皮,面部不增加额外切口,适合于面部较大面积创面的修复.

The Application of Prefabricated Superficial Temporal Fascia Postauricular Flap in the Repair of Huge Facial Defect

Objection To explore the application of prefabricated superficial temporal fascia postauricular flap in the repair of huge facial defect. Methods From 2007, 10 cases with huge facial defects were treated with prefabricated superficial temporal fascia postaurieular flap. Pedicled superficial temporal fascia flap was prefabricated under postaurieular skin with the tissue expander implanted simultaneously. After 3-5 months of skin expansion, the distribution of the new branches of prefabricated superficial temporal artery were observed by DSA. Then the tissue expander was removed and the islanded postauricular flap pedicled with superficial temporal artery was formed to repair the facial skin defect through tunnel. Results All the patients were followed up for 6 months to 1.5 years. Epidermis necrosis caused by the problem of venous return were observed in 2 cases and were recovered within 2 weeks. The other flaps were all survived. The largest area of flap was 7 cm×3.5 cm. The patients were all satisfied. Conclusion The prefabricated superficial temporal fascia postauricular flap is effective in the repair of huge facial defect with its thinner texture, enough tissue and no additional scar at face.