摘要
目的探探讨扩张后胸三角皮瓣修复颈部瘢痕挛缩畸形的临床效果。方法自2013年1月至2018年3月,对36例颈部瘢痕挛缩畸形的患者行扩张后胸三角皮瓣带蒂转移修复术,瘢痕面积为10 cm×7 cm^20 cm×13 cm。手术分3期:一期,于单侧或双侧胸三角皮瓣深筋膜浅层置入400~600 ml柱形或肾形扩张器,维持注水扩张2~3个月;二期行扩张器取出并形成扩张薄皮瓣,切除大部分颈部瘢痕,将皮瓣转移修复至创面,3~4周断蒂;三期,利用蒂部薄皮瓣修复剩余瘢痕切除后的创面。结果本组共36例(49个皮瓣)患者,其中44个皮瓣存活良好,1个皮瓣术后发生感染导致扩张器外露而提前断蒂进行修复,3个皮瓣远端早期出现青紫,经放血疗法、红光治疗后恢复,1个皮瓣远端坏死约3 cm×6 cm,经换药处理后行二期皮瓣蠕动修复。术后随访1~12个月,所有患者的皮瓣表面平整,色泽、质地、厚度与颈部正常皮肤相近,痛、温觉存在,且颈部活动度大于术前(P<0.05)。结论采用扩张后胸三角皮瓣修复颈部瘢痕挛缩畸形是一种利于术后颈部活动功能恢复,且效果较理想的方法。
Objective To explore the clinical efficacy of the use of an expanded deltopectoral flap in the repair of cervical scar contracture deformities. Methods From January 2013 to March 2018, the pedicled expanded deltopectoral flap was employed in 36 patients with cervical scar contracture. The area of scarring ranged from 10 cm × 7 cm to 20 cm × 13 cm. The operation was completed in three stages. In the first stage, a columnar or kidney-shaped expander from 400 ml to 600 ml was implanted into the superficial layer of the deep fascia of the unilateral or bilateral deltopectoral flap. Expansion was maintained for 2 to 3 months through water injection. In the second stage, the expander was taken out to form an expanded thin flap. Most of the cervical scars were cut and the flaps were transferred to repair the wounds. The pedicle was broken after 3 to 4 weeks. In the third stage, the pedicled thin flaps were used to repair the residual wounds after scar resection. Results In 36 patients(49 involved deltopectoral flaps), 44 flaps survived well, 1 flap suffered from infection after surgery and was repaired by early pedicle breakage. At the distal end of the 3 flaps, cyanoze occurred early and recovered after bloodletting therapy and red light therapy. One flap suffered about 3 cm × 6 cm of distal necrosis and was repaired by flaps at the second stage after dressing change. All patients were followed up for 1 to 12 months. All flaps were smooth and the color, texture, and thickness were similar to normal skin of the neck. Pain and temperature sensitivity were intact and the cervical activity was greater than that before the operation(P<0.05). Conclusion The employment of the expanded deltopectoral flap was an ideal method for the repair of cervical scar contracture deformity, and was beneficial in the recovery of cervical activity.
作者
吴琛
邹同荣
陈思思
WU Chen;ZOU Tong-rong;CHEN Si-si(Department of Plastic Surgery and Burn, The First People's Hospital of Yibin City, Yibin 644000, China)
出处
《中国美容整形外科杂志》
CAS
2019年第7期408-410,432,共4页
Chinese Journal of Aesthetic and Plastic Surgery
关键词
颈部瘢痕挛缩
扩张术
胸三角皮瓣
Cervical scar contracture
Dilatation
Deltopectoral flap
