扩张后皮瓣在面部美容整形中的应用

目的 探讨应用扩张后皮瓣修复面部色素痣、血管瘤、瘢痕等病损切除后创面的美容效果.方法 总结67例患者的治疗经验,根据面部病损的面积,选择适当容量的扩张器.切口一般选择在病损区,剥离平面位于SMAS筋膜浅层,剥离腔隙大于扩张囊边缘1.0～1.5 cm,止血完善后,置入扩张器,放置负压引流管.皮肤扩张充分后,扩张皮瓣的设计有推进皮瓣、旋转皮瓣、易位皮瓣等.推进转移利用扩张后的皮瓣面积充分,不需考虑供区缺损.易位皮瓣能最大限度利用扩张后皮瓣,并能克服旋转和推进皮瓣所带来的器官移位、变形等.同时,在面部设计皮瓣时应尽量减少切口,如切口不可避免时,使切口顺沿皮纹.结果 67例应用扩张后皮瓣修复面部病损切除后创面,皮瓣成活良好.术后效果满意.结论 面部有可供扩张的皮肤时,合理设计扩张后皮瓣修复病损切除后创面,是目前较好的治疗方法.

Application of expanded skin flap in facial aesthetic and plastic surgery

Objective To explore the aesthetic effect of the applying the expanded skin flap to re-pair facial defects produced by removal of nevus, hemangioma, scars and so on. Methods The experience of the treating 67 patients with facial lesions using the expanded flaps were reviewed. The proper expand-ers were chosen according to the scope of the facial lesion. The incision was located at the scar region and the dissection was executed in the superficial layer of the SMAS. The interspace was larger than the ex-pander by 1.0～1.5 cm. After exact hemostasis, the expanders and negative pressure drainage tubes were placed into the interspace. The design of the facial expanded skin flap included the advance, rotation, and transposition of skin flap and so on. The advance of skin flap took fully use of the expanded skin flap without the donor site defect. The transposition of skin flap also took fully use of the expanded skin flap, furthermore, it overcame the displacement and the disfiguration caused by the applying of the advance skin flap and rotation skin flap. The incisions in face were designed to a minimal extent and parallel to the Lan-ger line. Results All of the 67 cases got aesthetic satisfied results with all the flaps surviving. Conclusion The application of expanded skin flaps is proved to be an effective way of repairing facial wound when there is enough normal facial skin for expansion.