摘要:
Objective To investigate the clinical outcome of expanded frontotemporal flap pedicled with bilateral superficial temporal vessels,in repairing facial and cervical scar contracture deformity.Methods From January 2012 to December 2017,12 male patients with severe facial and cervical scar hyperplasia and contracture deformity,ranging from preauricular region,cheek,chin to neck,were treated in the Burn Department of the First People's Hospital in Zhengzhou.The patients were aged at 15-58 years,with the mean age of 29.3 years.The frontotemporal scalp flaps were simultaneously expanded to prefabricate a flap pedicled with bilateral superficial temporal arteries and veins.The operations were carried out in 3 stages.Stage Ⅰ:A 400-600 ml cylindrical expander was placed in the frontal region,underneath of galea aponeurosis and frontal muscle,meanwhile,a 50-100 ml cylindrical expander was placed in the temporal region on each side,between the deep temporal fascia and temporal muscle.Stage Ⅱ]:The expanded flap pedicled with bilateral superficial temporal vessels were received,to repair the secondary wound after scar resection and contracture release.The neck curve was reshaped.The donor area was directly sutured.Stage Ⅲ:The flap pedicle was repaired,and residual scar was removed.Laser hair removal was performed on the skin flaps about 3 weeks after operation.Results Seven patients underwent simultaneously cervical and thoracic tissue expansion.The expansion time was 5-6 months (average 5.2 months).The expanded flap was 40 cm×9 cm to 45 cm× 15 cm in size.Allflaps survived.The venous reflux disorder after the second stage operation occurred in 1 patient.The affected area was purple and swollen.It was recovered after acupuncture and compression bandage for 1 week.Laser hair removal was performed in 8 flaps.Flap thinning was performed in 5 flaps.All 12 patients were followed up for 4 to 24 months.The flaps have good appearance,without bloating.The transferred flaps have similar color and texture with adjacent the facial skin.The cervical mobility was significantly improved.The hairline of the head was normal,and the suture scar was slight and concealed.Conclusions The expanded frontal and temporal flaps provide considerable amount of tissue with thin skin and reliable blood supply.It is an alternative method to repair facial and cervical scar contracture.%目的 探讨以双侧颞浅血管为蒂的额颞部扩张皮瓣修复面颈部瘢痕挛缩畸形的临床效果.方法 2012年1月至2017年12月,郑州市第一人民医院烧伤科收治12例面颈部严重瘢痕增生、挛缩畸形男性患者,包括耳前、面颊、颏颈部大面积瘢痕,年龄15~58岁,平均29.3岁.对额部、颞部头皮同期扩张,形成以双侧颞浅动、静脉血管为蒂的额颞部扩张皮瓣进行修复.手术分三期进行:(1)一期手术于额顶部置入400~600 ml圆柱形扩张器1枚,置入层次在帽状腱膜及额肌下,两侧颞部各置入50~ 100 ml圆柱形扩张器1枚,置入层次在颞深筋膜与颞肌之间.(2)二期切取以双侧颞浅血管为蒂的扩张皮瓣,转移修复颌颈部瘢痕切除及挛缩松解后的继发创面,重塑颈部曲线,供瓣区直接拉拢缝合.(3)三期行皮瓣断蒂修整及剩余瘢痕切除修复术.术后3周左右对皮瓣行激光脱毛处理.结果 本组12例患者,其中7例联合颈胸部皮肤同期扩张.注水扩张时间5~6个月,平均5.2个月,扩张后切取皮瓣面积40 cm×9 cm~45 cm×15 cm,12例皮瓣转移后均成活,其中1例二期术后皮瓣出现静脉回流障碍,呈现紫色、肿胀,给予针刺放血、按压处理,1周后完全恢复.8例皮瓣进行激光脱毛处理,5例因皮瓣臃肿进行了修薄.12例患者随访4 ~ 24个月,皮瓣外观良好,无臃肿,色泽、质地与面部皮肤相近.颈部活动度明显改善,头部发际线正常,缝合口瘢痕轻微且隐蔽.结论 额、颞部皮肤扩张后能够提供较大面积的薄皮瓣,血运可靠,是修复面颈部瘢痕挛缩较佳的方法.