圆形扩张器扩张颈部-耳后联合皮瓣进行全颊部美学修复

摘要

目的：探讨利用圆形扩张器扩张颈部-耳后联合皮瓣进行全颊部瘢痕一次性美学修复的可行性及优势，为临床推广应用提供参考。方法：2009年-2013年，笔者对18烧伤后全颊部瘢痕的患者（23侧颊部）进行美容性修复。使用200ml或300ml圆形扩张器扩张颈部皮肤，扩张完成后，取出扩张器，并将附加切口向耳后及后发际线延伸，以旋转推进的方式利用扩张皮瓣修复全颊部大面积瘢痕。供区一期缝合。结果：全部皮瓣均成活良好.平均皮瓣面积为9.8cm×7.8cm。扩张器扩张及手术过程中出现个别轻微并发症，经积极处理，未对最终手术结果照成影响。术后常规随访，平均随访年限为2.3年，皮瓣回缩率较低，供区外观功能良好，附加切口隐蔽，效果稳定。结论：圆形扩张器扩张颈部-耳后联合皮瓣为全颊部瘢痕的修复提供了颜色、质地、形状高度相似的组织，符合美学单位修复概念。以旋转为主、辅以推进的转移方式使皮瓣的利用率得以提高，垂直方向上的张力减小，供区形态功能得以保全。本方法操作简便，是一种安全可行的颊部瘢痕修复方法。%Objective To evaluate the advantage and feasibility of using round expander in cervico-periauricular area to provide large flap enough for whole cheek reconstruction.Provide a reference for the clinical selection of appropriate treatment options. Methods From 2009 to 2013,18 burn sequala patients(23 cheeks)underwent this two-staged operation for aethsetic reconstruction.A round tissue expander (200ml or 300ml) was inserted in the cervico area in the first stage.After proper expansion, the tissue expender was removed and an additional incision was made along the periauricular area. The whole cheek reconstruction was received by expanded flap in a rotation-advancement way. Results All flaps survived.The average size of the flaps was 9.8cm × 7.8cm.A few of minor complications happened during expansion period and operation, which were controlled by actively treatments without affection of the final results.The patients were under regular follow-up,with an average follow-up period of 2.3 years.Flap’s retraction rate was low, the function and apperence of the donor site was good,and the additional incision was well-concealed.The results were stable. Conclusion Round expander in cervico-periauricular area provides large flap for whole cheek reconstruction with similar color,texture and shape.It conforms to the concept of aesthetic unit repair. Rotation along with advancement enlarges the usage of the flap and reduces the longitudinal contraction,which allows the donor site being well-concealed and preserved.This is a simple,safe and feasible method for cheek scar reconstruction.