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以胸廓内动脉穿支为蒂的预扩张胸三角皮瓣游离移植整复面部瘢痕的临床效果

何林 朱婵 贾晶 周林 张卓 舒茂国

何林, 朱婵, 贾晶, 等. 以胸廓内动脉穿支为蒂的预扩张胸三角皮瓣游离移植整复面部瘢痕的临床效果[J]. 中华烧伤与创面修复杂志, 2023, 39(3): 241-247. DOI: 10.3760/cma.j.cn501225-20220123-00012.
引用本文: 何林, 朱婵, 贾晶, 等. 以胸廓内动脉穿支为蒂的预扩张胸三角皮瓣游离移植整复面部瘢痕的临床效果[J]. 中华烧伤与创面修复杂志, 2023, 39(3): 241-247. DOI: 10.3760/cma.j.cn501225-20220123-00012.
He L,Zhu C,Jia J,et al.Clinical effects of free pre-expanded internal thoracic artery perforator pedicled deltopectoral flap transfer in facial scar reconstruction[J].Chin J Burns Wounds,2023,39(3):241-247.DOI: 10.3760/cma.j.cn501225-20220123-00012.
Citation: He L,Zhu C,Jia J,et al.Clinical effects of free pre-expanded internal thoracic artery perforator pedicled deltopectoral flap transfer in facial scar reconstruction[J].Chin J Burns Wounds,2023,39(3):241-247.DOI: 10.3760/cma.j.cn501225-20220123-00012.

以胸廓内动脉穿支为蒂的预扩张胸三角皮瓣游离移植整复面部瘢痕的临床效果

doi: 10.3760/cma.j.cn501225-20220123-00012
基金项目: 

陕西省重点研发计划 2023-YBSF-179

西安交通大学第一附属医院新医疗新技术 XJYFY-2020W13

详细信息
    通讯作者:

    舒茂国,Email:shumaoguo@163.com

Clinical effects of free pre-expanded internal thoracic artery perforator pedicled deltopectoral flap transfer in facial scar reconstruction

Funds: 

Key Research and Development Plan of Shaanxi Province of China 2023-YBSF-179

New Medical Technology of the First Affiliated Hospital of Xi'an Jiaotong University XJYFY-2020W13

More Information
  • 摘要:   目的   探讨通过彩色多普勒超声行术前血管评估,选取合适的胸廓内动脉穿支并以其为蒂,行预扩张胸三角皮瓣游离移植整复面部瘢痕的临床效果。   方法   采用回顾性观察性研究方法。2017年9月—2021年3月,西安交通大学第一附属医院收治11例符合入选标准的面部瘢痕患者,其中男6例、女5例,年龄16~58(31±12)岁,瘢痕面积7 cm×5 cm~14 cm×9 cm,均采用以胸廓内动脉穿支为蒂的预扩张胸三角皮瓣游离移植整复。手术分2期或3期进行,术前用彩色多普勒超声对胸廓内动脉血管穿支进行评估。Ⅰ期行皮肤软组织扩张器(以下简称扩张器)置入术,于胸壁置入1个额定容量为400~600 mL的圆柱形扩张器,扩张3~4个月,注水量为扩张器额定容量的1.2~1.5倍。Ⅱ期行瘢痕切除+预扩张胸三角皮瓣游离移植术,皮瓣切取面积为9 cm×7 cm~16 cm×10 cm。将皮瓣血管蒂(胸廓内动脉肋间穿支血管)与面动静脉或者颞浅动静脉进行端端吻合,供区创面直接缝合。5例患者因皮瓣蒂部臃肿在Ⅱ期术后3~6个月行Ⅲ期皮瓣修薄术。在末次手术后6个月统计皮瓣存活、并发症发生情况,并采用塞姆斯温斯坦单丝测验评价皮瓣感觉,将皮瓣与周围正常皮肤颜色进行对比来评价色泽,采用利克特5级量表评价患者的疗效满意度。   结果   末次手术后6个月,11例患者皮瓣全部存活良好。1例患者皮瓣移植术后出现静脉危象,行二次血管吻合后皮瓣成活;1例患者在Ⅰ期扩张器置入术后出现血肿,清除后未影响后续治疗;所有患者均无感染、扩张器外露等并发症发生。末次手术后6个月,患者皮瓣感觉:9例达到保护性感觉减弱及以上,1例保护性感觉缺失,1例仅存在深部触压觉;患者皮瓣色泽:3例与周围正常皮肤颜色非常接近,6例与周围正常皮肤颜色接近,2例与周围正常皮肤颜色有差异;患者的疗效满意度:2例非常满意,6例满意,2例一般满意,1例有点不满意。   结论   对于大面积面部瘢痕,通过彩色多普勒超声行术前血管评估,选取合适的单一胸廓内动脉穿支作为血管蒂进行预扩张胸三角皮瓣游离移植整复安全有效。术后患者面部皮瓣颜色与周围正常皮肤组织接近,并可恢复部分感觉,患者对疗效的满意度高。

     

  • 1  以胸廓内动脉穿支为蒂的预扩张胸三角皮瓣游离移植整复例1患者面部瘢痕伴眼球外露的效果。1A.Ⅰ期术前可见右面部瘢痕、右眼睑缺损、右侧鼻翼部分缺损,瘢痕挛缩致下睑严重外翻及鼻翼、口角牵拉变形;1B.胸壁置入的皮肤软组织扩张器注水扩张完成后,扩张皮肤无破溃;1C.皮瓣预处理后;1D.切取以胸廓内动脉第2肋间穿支为蒂的预扩张胸三角皮瓣;1E.Ⅱ期皮瓣移植术后即刻;1F.Ⅲ期术后半年,面部外观良好,皮瓣颜色与周围正常皮肤接近,右眼睑缺损得到修复

    2  移植2种扩张皮瓣整复例2患者双侧面部瘢痕的效果。2A.左面部Ⅰ期术前,瘢痕色泽较深,伴口角牵拉变形;2B.右面部Ⅰ期术前,瘢痕色泽不均,伴口角牵拉变形;2C.左面部置入的皮肤软组织扩张器注水扩张完成后;2D.切取以胸廓内动脉第2肋间穿支为蒂的预扩张胸三角皮瓣;2E、2F.分别为左面部、右面部Ⅱ期术后1年,面部外观良好,左面部皮瓣颜色与周围正常皮肤一致,右面部皮瓣颜色与周围正常皮肤非常接近

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