游离皮瓣联合预构扩张皮瓣修复面颈部瘢痕

张月 韩飞 官浩

[摘要]目的：探討游离皮瓣联合预构扩张皮瓣修复面颈部大面积瘢痕的疗效。方法：2017年6月-2019年6月，应用游离皮瓣联合预构扩张皮瓣修复6例烧伤后患者的面颈部瘢痕。一期设计游离皮瓣修复颈部瘢痕的同时于前躯正常皮肤处设计预构扩张皮瓣，取长约10～14cm的旋股外侧动脉降支血管蒂作为预置血管，将扩张器及预置血管一同置入预扩张的皮瓣内。待扩张器扩张满意后，行二期手术，修复面部瘢痕。结果：分区（面部为一区，颈部为另一区）分次（一期修复颈部瘢痕及置入扩张器，待扩张器扩张满意后二期修复面部瘢痕）修复面颈部大面积瘢痕，两个皮瓣融合良好，未发生术后并发症。随访3～12个月，面部术区与周围皮肤色泽质地及厚薄均相近，张口及表情功能良好，下颌弧度接近正常，颈部活动得到明显改善，两处供瓣区仅留两条线性瘢痕。结论：游离皮瓣联合预构扩张皮瓣是修复面颈部大面积瘢痕较好的方法，供区损伤小，患者满意。

[关键词]瘢痕;面颈部;预构扩张皮瓣;扩张器;游离皮瓣;分区修复

[中图分类号]R619+.6    [文献标志码]A    [文章编号]1008-6455（2021）04-0078-03

Repair of Faciocervical Scar with the Combination of Free Flap and Prefabricated Expanded Flap

ZHANG Yue，HAN Fei，GUAN Hao

（Department of Burns and Cutaneous Surgery，Xijing Hospital，Air Force Medical University，Xi'an 710032，Shaanxi，China）

Abstract： Objective  To explore the effect of free flap combined with prefabricated expanded flap in the repair of large faciocervical scar. Methods  From June 2017 to June 2019， 6 patients suffered from faciocervical scars were included. Scars were repaired by free flap combined with prefabricated expanded flap. In the first stage， scar in neck was removed and repaired by free flap， and expander was implanted into adjacent area. In the meantime， the descending branch of the lateral circumflex femoral artery with a length of about 10-14cm was taken as the preset blood vessel. Anastomosis was done and vessels were put superior to the expander. When the expansion was satisfying， patients went through the second stage surgery. The bridging free flap was taken to repair the scar of face. Results  The faciocervical area was divided into two districts as facial district （Ⅰ district） and cervical district （Ⅱ district）. In the first stage， scar in cervical district was removed and repaired， expander was implanted. In the second stage， scar in facial district was repaired. Two flaps were connected and healed well without complications. Patients were followed up for 3-12 months. It was found that the color， texture and thickness of the flap in face were similar to the surrounding area. Mouth opening and facial expression were good. The mandible curve was close to normal. The neck movement was significantly improved than before. Only linear scars were left in the donor sites. Conclusion  Free flap combined with prefabricated expanded flap is a promising method to repair large area of faciocervial scar with minor damage in the donor site.

Key words： scar; face and neck; prefabricated expanded flap; expander; free flap; partition repair

由烧、创伤等各种原因造成的面颈部大面积瘢痕，破坏了正常皮肤的质地颜色，影响外貌的同时造成面颈部解剖移位及功能受限，如睑外翻、唇外翻、小口畸形、鼻孔缺失等，严重影响患者身心健康，给患者及家庭造成极大痛苦。此类患者单纯行全（中）厚皮片或者皮瓣移植虽可改善面颈部瘢痕挛缩畸形的情况，但皮肤愈合后，色泽质地及厚薄上均无法达到满意效果。……