扩张后颈肩皮瓣修复颈部瘢痕挛缩临床研究

目的:探讨应用扩张后颈肩皮瓣修复颈部瘢痕挛缩的临床疗效.方法:选择颈部瘢痕患者32例,采用大容量扩张器常规扩张颈肩部皮瓣,6-8周后转移颈肩部皮瓣,完成颈部瘢痕挛缩修复治疗.移植皮瓣面积为5 cm×11 cm-12 cm×21 cm.结果:扩张器置入后充盈良好,无外露、渗漏,局部血肿、感染各2例,予局部冲洗及抗感染治疗后正常扩张;扩张皮瓣无破溃、血运不良.瘢痕均为一次性彻底切除,30例术后切口Ⅰ期愈合,2例切口感染,予换药、抗感染治疗后愈合良好,随访3个月皮瓣完好成活,无局部血运障碍,局部形态良好,颈部活动自如,术区外观满意.结论:扩张后颈肩皮瓣质地好、色泽与待修复区相近、皮瓣面积大、血运丰富,同时供区较易闭合且后期瘢痕不易暴露,在颈部瘢痕挛缩修复中具有重要的应用价值.

Application of Expanded Cervico-Acromial Flap in Repairing Cervical Cicatricial Contracture

Objective: To study the effects of the application of expanded cervico-acromial flap in repair of cervical cicatricial contracture.Methods: Thirty-two patients with cervical cicatricial contracture were included into the study.We expanded the cervico-acromial flap for 6-8 weeks with large volume tissue expander,then repair the cervical cicatricial contracture.The area of cervico-acromial flap transplanted was 5 cm×11 cm-12 cm×21 cm.Results: Large volume tissue expander was implanted without exposure or seepage.Only 2 cases of local hematoma and 2 cases of infection happened during expanding and treated with local washing and anti-infection treatment.There was no diabrosis and blood supply obstruction in expanded flaps.All 32 patients were received cicatrices resection by one stage,and 30 cases reached healing by first intention.Two cases got infection,and also healed after dressing change and anti-infection treatment.The grafted flaps survived without blood supply obstruction,with good appearance and neck activity after three months’ follow-up.Conclusion: Expanded cervico-acromial flap has fine quality,and the color similar to the normal skin,with large area and rich blood supply.Donor site heals easily with less exposure.The application of expanded cervico-acromial flap has important clinical value in repair of cervical cicatricial contracture.