目的:探讨双侧扩张颈横动脉浅支皮瓣联合应用局部颈部筋膜瓣行颌颈角成形对严重颈部挛缩性瘢痕的修复效果.方法:对12例颈部烧伤后严重瘢痕挛缩畸形患者,一期双侧前胸壁置入皮肤扩张器并注水,注水量约800～1000ml,注水完成后行皮瓣延迟术.二期行颈部瘢痕切除,局部形成5cm×3cm筋膜瓣并向上折叠加深颌颈角,扩张皮瓣转位修复瘢痕切除后创面.供区扩张皮瓣或皮片修复.结果:12例患者术后皮瓣均成活良好,仅2例皮瓣远端出现少许坏死,后期予以换药或植皮修复,随访3个月～2年患者面颈部外形、功能均得明显改善.结论:扩张颈横动脉浅支皮瓣联合局部筋膜瓣颌颈角成形能较好地改善颈部严重瘢痕挛缩畸形患者面颈部外观及功能,是一种简单有效的手术方法.%Objective To investigate the long-term effect of the joint application of dilated carotid artery superficial flap and Local fascial flap reshaping jaw neck angle to the repair of severe neck contracture.Methods 12 cases with serious scar contracure deformity of neck after by burnt were underwent two-stage surgery.In the first stage of the operation,two tissue expander with a volume 400ml were embed under both sides of the cervical cutaneous branch of the transverse cervical artery and conducted with conducted with injection of water about 800-1 000ml.then they were conducted with flap delay surgery after completion of water injection.In the second stage of the operation,the scar was excised and fully released at first,and then 5cm×3cm local fascial flap was folded upward to reshaping jaw neck angle,later the expanded flaps of the cervical cutaneous branch of the transverse cevical artery were used to cover the wound.The donor sites were closed directly or skin plant.Results All the flaps survived well,only 2 flaps came with a little necrosis in distant place.Which were repaired with dressing change or thickness skin-grafting.All the cases were followed from 3 months to 2 years,appearance and functions of face and neck for the patients were apparently improved.Conclusion The expanded flaps taken from both sites of the cervical cutaneous branch of the transverse cervical artery combined with Local fascial flap of maxillary neck was effective in the repair of the neck and napex scars,which can improve the appearance and function of face and neck of patients with severe scar contracture.It is a simple and effective procedure.
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