颞顶筋膜岛状瓣植入耳后乳突区预制扩张筋膜皮瓣修复面部皮肤软组织缺损

目的探讨一种较好的修复面部皮肤软组织缺损的手术方法。方法手术分两期进行。一期手术时,以颞浅动静脉为蒂,掀起颞顶浅筋膜岛状瓣,沿同侧发际线切开,在耳后乳突区皮下剥离,形成适当大小的囊腔,将颞顶筋膜瓣转移至囊腔内,适当固定,于筋膜瓣下放置皮肤扩张器;扩张完毕后,取出扩张器,以颞浅动静脉为蒂,掀起耳后乳突区预制岛状筋膜皮瓣,用于面部皮肤缺损的修复。结果自1999年以来,临床应用9例,其中面部黑痣2例,面部血管瘤2例,面部瘢痕5例。颞顶筋膜岛状皮瓣蒂长5.5~7cm,平均6.2cm,筋膜瓣面积4cm×3cm~7cm×7cm,平均5.7cm×4.9cm,预制筋膜皮瓣面积为5cm×5cm~8.0cm×7.5cm,平均6.4cm×6.1cm;术后皮瓣全部成活,供瓣区直接拉拢缝合者5例,另行皮片移植修复者4例。结论颞顶筋膜皮瓣血管蒂长,转移方便,血运丰富,耳后乳突区皮肤在质地、色泽、厚度等方面均与面部皮肤最为接近,是一种良好的修复面部皮肤软组织缺损的方法。

Repair of the facial defects using the expanded induced prefabricated skin flap of the retroauricular and mastoid process region based on the superficial temporal vascular bundle

OBJECTIVE: To provide an ideal method for flap prefabrication. METHODS: The superficial temporal fascial flap has been elevated based on the superficial temporal vessels during the first-stage procedure. A subcutaneous tissue pocket with appropriate site was formed in the retroauricular and mastoid process region. The fascial flap was transferred into the pocket and fixed properly. The tissue expander was placed under the fascial flap. When the expanding process has been finished, the expander was removed and the expanded induced prefabricated skin flap of the retroauricular and mastoid process region pedicled on the superficial temporal vascular bundle was elevated and transferred to repair the facial skin defect. RESULTS: There were nine cases in the group. Facial defects after resection of the melanotic nevus was repaired in 2 cases and facial defects after resection of the facial hamangioma and scar were repaired in 2 and 5 cases respectively. Pedicle length of the superficial temporal fascial flap was ranged from 5.5 cm to 7 cm (mean length 6.2 cm). The size of the fascial flaps was ranged from 4 cm x 3 cm to 7 cm x 7 cm (mean size 5.7 cm x 4.9 cm). The size of the prefabricated skin flaps was ranged from 5 cm x 5 cm to 8.0 cm x 7.5 cm (mean size 6.4 cm x 6.1 cm). The average time of the tissue expansion process is 16.1 weeks. All flaps survived postoperatively and the donor sites of the flaps were appropriated directly in 5 cases. The split-thickness skin grafting was used to recover the donor site defects in 4 cases. CONCLUSIONS: The superficial temporal fascial flap owns the following advantages: the vascular pedicle is much longer and vascular supply is plentiful, and it is convenient to transfer. Meanwhile, the skin of the retroauricular and mastoid process region is most similar to that of the face in texture, color and depth. For the patients selected strictly, the technique mentioned above is somewhat an ideal method for facial defect repair.