Application effects of CT angiography and three-dimensional reconstruction technique in repairing scar around the mouth and chin with expanded forehead axial flap
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摘要: 目的 探讨CT血管造影(CTA)及三维重建在额部轴型扩张皮瓣修复口周及颏部瘢痕中的应用效果。 方法 2013年6月—2017年10月,笔者单位收治9例面部深度烧伤后口周及颏部瘢痕增生患者,瘢痕面积为8 cm×7 cm~13 cm×8 cm。于患者额部置入1枚额定容积为400~500 mL圆柱形皮肤软组织扩张器,5~6个月后行口周及颏部瘢痕切除、皮肤软组织扩张器取出,应用携带双侧颞浅血管蒂的额部轴型扩张皮瓣修复瘢痕切除后继发创面,其中3例患者同时行小口畸形矫正术。术前行CTA及三维重建,获得供瓣区颞浅动脉及其分支三维图像,明确颞浅动脉及其分支走行、毗邻定位、血管吻合情况,指导皮瓣的设计。本组患者皮瓣切取面积25 cm×9 cm~30 cm×8 cm。术后2~3周行皮瓣断蒂、蒂部复位修整术。供瓣区直接拉拢缝合。皮瓣修复术后10~12 d,应用半导体冰点激光对皮瓣部位行脱毛处理,每个月1次,共4~6次。 结果 本组所有患者术后皮瓣均存活良好,无血运障碍,其中3例患者术后皮瓣稍臃肿,于术后3个月行皮瓣修薄术,术后皮瓣外观自然。术后随访6个月~2年,皮瓣色泽、质地、厚度与周围正常皮肤相近,口周及颏部外形及张口功能明显改善,瘢痕未再复发。额颞部切口隐蔽,头部毛发生长正常,重建发际线自然。 结论 额部轴型扩张皮瓣修复口周及颏部瘢痕,术区外形、功能较佳,供区形态良好。CTA及三维重建能提供清晰的额部轴型扩张皮瓣中颞浅动脉及其分支三维图像,为术前皮瓣设计提供可靠依据,降低手术风险,提高皮瓣成活率,具有临床应用价值。Abstract: Objective To explore application effects of CT angiography (CTA) and three-dimensional reconstruction technique in repairing scar around the mouth and chin with expanded forehead axial flap. Methods From June 2013 to October 2017, 9 patients with hyperplastic scar around the mouth and chin after deep burns on face were admitted to our unit. The sizes of scars of patients ranged from 8 cm×7 cm to 13 cm×8 cm. One cylindrical skin soft-tissue dilator with nominal volume of 400 to 500 mL was implanted in forehead area of each patient. Five to six months after the dilator was implanted, scar around the mouth and chin was resected, and the dilator was removed. The secondary wound after scar resection was repaired by expanded forehead axial flap with bilateral superficial temporal vessel pedicles. Three of the nine patients received microstomia diorthosis at the same time. Before the operation, CTA and three-dimensional reconstruction were applied to obtain three-dimensional images of superficial temporal arteries and the branches in the donor site, which could identify the travel, adjacent location, and vascular anastomosis of the above-mentioned vessels to guide flap design. The sizes of flaps of patients ranged from 25 cm×9 cm to 30 cm×8 cm. Two to three weeks after the operation, flap pedicles were cut off, restored, and trimmed. The donor site was sutured directly. Ten to twelve days after the flap repair operation, the flap site received depilation treatment with semiconductor freezing point laser once a month for 4 to 6 times. Results Flaps of all patients survived well, with no blood circulation disorder. The flaps of three patients were slightly bulky, while they were with natural appearance after flap thinning operation in 3 months post flap repair operation. During follow-up of 6 months to 2 years after the operation, color, texture, and thickness of the flaps were close to normal skin around scars. The appearance of perioral and mental region, and opening function of mouth improved significantly, with no recurrence of scar. Frontotemporal incision was hidden, hair on head grew normally, and reconstructed hairline was natural. Conclusions Scar around the mouth and chin repaired with expanded forehead axial flap were with good appearance and function in operation area and good shape in donor site. CTA and three-dimensional reconstruction technique can provide clear three-dimensional images of superficial temporal arteries and the branches in expanded forehead axial flaps, which can provide reliable basis for preoperative designing of flap, reduce operative risk, and improve survival rate of flap, thus having clinical application value.
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Key words:
- Cicatrix /
- Dilatation /
- Angiography /
- Surgical flaps /
- Three-dimensional reconstruction /
- Computed tomography
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