局部筋膜瓣联合植皮在头面部骨外露创面修复中的应用

熊清华 刘诚 李小林

[摘要]目的：探讨运用局部筋膜瓣加植皮修复头面部骨外露创面的临床疗效。方法：选择2016年6月-2018年12月笔者科室应用局部筋膜瓣加植皮修复有骨外露的头面部创面13例患者，其中外伤6例，皮肤恶性肿瘤7例。根据创面面积大小及形状，在创面旁切取获得适当大小筋膜瓣，范围3cm×6cm～6cm×9cm，经折叠后覆盖骨外露创面，将中厚皮片植于筋膜瓣上，术后观察植皮成活情况，评估临床疗效。结果：13例患者筋膜瓣及植皮均成活良好，术后随访1～6个月，外形良好。结论：局部筋膜瓣加植皮修复骨外露创面效果肯定，外形好，值得在临床推广使用。

[关键词]头面部;骨外露创面;局部筋膜瓣;植皮;修复

Abstract： Objective  To explore the clinical effect of using local fascial flap and skin-grafting to repair the exposed bone wounds on the head and face. Methods From June 2016 to December 2018， 13 cases of head and face wounds with bone exposure were repaired by local fascial flap and skin grafting， including 6 cases of trauma patients and 7 cases of skin malignant tumors. According to the size and shape of the wound area， an appropriate size fascial flap was obtained at the side of the wounds， with a range of 3cm×6cm-6cm×9cm， which folds and covers the exposed bone， and the medium-thick skin was implanted on the fascial flap. The survival of skin grafting was observed after surgery， and the clinical efficacy was evaluated. Results  13 patients with fascial flap and skin grafts survived well. Conclusion Local fascial flap and skin grafting is effective in repairing bone exposed wounds ， which can improve wound healing effect and is worthy of clinical application.

Key words： head and face; exposed bone wound; local fascial flap; skin grafting; repair

临床上外伤致头面部组织严重缺损及皮肤恶性肿瘤扩大切除术后的患者，均可以出现颅骨或面骨的部分暴露。对于这种创面的修复，传统的修复办法是采用局部或游离皮瓣加以修复，但是局部皮瓣对于面部外伤患者来说，会产生大量新的瘢痕，影响外观，对于头皮斑秃的患者来说头皮无弹性，也不宜使用;而游离皮瓣本身对术者及手术器械均要求较高，开展难度大，且术后多出现局部外形臃肿，患者不易接受。鉴于此，笔者尝试采用局部筋膜瓣加植皮来修复头面部骨外露创面，取得了满意的效果，现将结果报道如下。

1  資料和方法

1.1 一般资料：本组患者共13例，其中外伤6例，皮肤恶性肿瘤7例。外伤组患者均为车祸导致，其中男5例，女1例，年龄18～50岁，平均32岁。其中右颧……