目的 探讨以滑车上动脉或眶上动脉穿支为蒂的扩张额部螺旋桨皮瓣修复面部缺损的可行性和技术要点.方法 应用以滑车上动脉或眶上动脉穿支为蒂的预扩张额部螺旋桨皮瓣修复面部缺损.一期手术时,在额肌下埋置扩张器,扩张完毕后,将扩张的额部皮瓣以滑车上动脉或眶上动脉穿支穿出点作为旋转点,旋转转移修复面中部缺损.如缺损位于鼻部,供瓣区可直接关闭;如果缺损位于颊部或下睑,则皮瓣需跨越眼裂,3周后行断蒂手术.结果 2010年7月至2016年7月,应用该方法修复8例患者的面部缺损,5块皮瓣以滑车上动脉穿支为蒂,3块皮瓣以眶上动脉穿支为蒂.扩张器大小为150 ～300 ml,扩张时间4～7个月,平均5.4个月.面部缺损大小为5.5 cm×2.5 cm ～ 9.5 cm×6.0cm;螺旋桨皮瓣面积为10 cm×6 cm ～ 15 cm×13 cm,术后皮瓣全部成活,无静脉回流不畅、皮瓣坏死等并发症.随访时间为3 ～ 36个月,平均10个月.6例患者术后分别实施了眉形修整、皮瓣修薄、瘢痕整形等手术.患者或其家属均对手术效果表示满意.结论 对于选择恰当的病例,以滑车上或眶上动脉穿支为蒂的额部预扩张螺旋桨皮瓣是修复面部缺损的方法之一.%Objective To investigate the feasibility and technical tips of repairing facial defectswith pre-expanded propeller flap based on the perforators of the supratrochlear artery or the supraorbital artery.Methods In the first-stage operation,a tissue expander was buried underneath the frontalis muscle.The second-stage operation was conducted using pre-expanded supratrochlear artery or the supraorbital artery based propeller flap to repair facial defect.Results From July 2010 to July 2016,this method was used in 8 patients.5 flaps were based on the supratrochlear artery,and 3 flaps based on the supraorbital artery.Expander size was ranged from 150 ml to 300 ml.The size of propeller flaps was from 10 cm × 6 cm to 15 cm × 13 cm.All the flaps survived without any major complications.Follow-up period ranged from 3 to 36 months.Eyebrow replacement,flap thinning and scar revision were performed in 6 cases.All patients were satisfied with the final aesthetic result.Conclusions The pre-expanded propeller flap based on the supratrochlear artery or the supraorbital artery is an alternative option to repair the facial defect in appropriate cases.
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