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Volume 38 Issue 4
Apr.  2022
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Article Navigation >  CHINESE JOURNAL OF BURNS AND WOUNDS  > 2022  >  38(4): 306-312
Zhang JP,Yuan X,Jiang XP,et al.Aesthetic reconstruction of the scar contracture deformity in chin and neck with expanded flaps based on the "MRIS" principle[J].Chin J Burns Wounds,2022,38(4):306-312.DOI: 10.3760/cma.j.cn501120-20211130-00401.
Citation: Zhang JP,Yuan X,Jiang XP,et al.Aesthetic reconstruction of the scar contracture deformity in chin and neck with expanded flaps based on the "MRIS" principle[J].Chin J Burns Wounds,2022,38(4):306-312.DOI: 10.3760/cma.j.cn501120-20211130-00401.
shu

Aesthetic reconstruction of the scar contracture deformity in chin and neck with expanded flaps based on the "MRIS" principle

doi: 10.3760/cma.j.cn501120-20211130-00401

  • Department of Plastic Surgery, State Key Laboratory of Trauma, Burns and Combined Injury, the First Affiliated Hospital of Army Medical University (the Third Military Medical University), Chongqing 400038, China

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  • Corresponding author: Zhang Jiaping, Email: 1980475546@qq.com
  • Received Date: 2021-11-30
    Abstract
  •     Objective   The surgical reconstruction strategy for scar contracture deformity in chin and neck was explored, aiming to obtain better aesthetic outcome.    Methods   A retrospective observational study was conducted. From December 2017 to April 2021, 34 patients with scar contracture deformity in chin and neck after burns were hospitalized in the Department of Plastic Surgery of the First Affiliated Hospital of Army Medical University (the Third Military Medical University), aged 12-54 years, including 13 males and 21 females, 4 cases with chin affected only, 7 cases with neck affected only, and 23 cases with both chin and neck affected. The scar areas were 48-252 cm2. All the patients were treated by operation with expanded flaps, following the "MRIS" principle of matching of the color and thickness of the repair flaps (match), reconstructing of the aesthetic features of subunits (reconstruction), design of incision according to the plastic principle (incision), and prevention of the surgical incision scar (scar). The rectangular or kidney shaped skin and soft tissue expander (hereinafter referred to as the expander) with rated capacity of 80-400 mL was embedded in the first stage, which was routinely expanded to 3-5 times of the rated capacity of the expander. In the second stage, scar resection and expanded flap excision were performed to repair the secondary wound, and the flap donor site was sutured directly. The expansion ratio of the expander (with average value being calculated), the type of flaps used, the reconstruction of local aesthetic morphology, the appearance of postoperative incision, the survival of flap, and the situation of donor and recipient sites observed during follow-up were recorded.    Results   Among the 34 patients, the average expansion ratio of the implanted expander was 3.82 times of the rated capacity of the expander. Three cases were repaired by the expanded local pedicled flap only, 19 cases by the expanded shoulder and/or chest perforator pedicled flap only, 10 cases by the expanded local pedicled flap combined with the expanded shoulder and/or chest perforator pedicled flap, and 2 cases by the expanded local pedicled flap combined with the expanded free flap of the second intercostal perforator of internal thoracic artery. After scar resection, the shapes of lower lip and chin-lip groove were reconstructed in 10 cases, chin process reconstruction and chin lengthening were performed in 16 cases, and the cervico-mental angle and mandibular margin contour were reconstructed in 28 cases. The surgical incision was concealed, most of which were located at the natural junction or turning point of the chin and neck subunits. The vertical incision of neck was Z-shaped or fishtail-shaped. All the expanded flaps in 34 patients survived after operation, of which 8 patients had minor necrosis at the edge or tip of the expanded flaps 1-3 days after operation and healed after dressing change. During the follow-up of 3-18 months, little difference in color and thickness between the expanded flap and the skin of chin and neck was observed, and the aesthetic shape of chin and neck was significantly improved, with mild scar hyperplasia of surgical incision.    Conclusions   Reconstruction of scar contracture deformity in chin and neck by using expanded flaps based on the "MRIS" principle is beneficial to improve the quality of surgery and achieve better aesthetic outcome.

     

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    • References(19)
  • [1]
    AkitaS,HayashidaK,TakakiS,et al.The neck burn scar contracture: a concept of effective treatment[J/OL].Burns Trauma,2017,5:22[2022-02-10]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5508764/.DOI: 10.1186/s41038-017-0086-8.
    [2]
    Gonzalez-UlloaM.Restoration of the face covering by means of selected skin in regional aesthetic units[J].Br J Plast Surg,1956,9(3):212-221.DOI: 10.1016/s0007-1226(56)80036-2.
    [3]
    EdgertonMT,HansenFC.Matching facial color with split thickness skin grafts from adjacent areas[J].Plast Reconstr Surg Transplant Bull,1960,25:455-464.DOI: 10.1097/00006534-196005000-00001.
    [4]
    冯少清,苏薇洁,喜雯婧,等.颈部烧伤后瘢痕挛缩畸形的手术策略[J].中华烧伤杂志,2015,31(4):280-284.DOI: 10.3760/cma.j.issn.1009-2587.2015.04.012.
    [5]
    LellouchAG,NgZY,PozzoV,et al.Reconstruction of post-burn anterior neck contractures using a butterfly design free anterolateral thigh perforator flap[J].Arch Plast Surg,2020,47(2):194-197.DOI: 10.5999/aps.2019.00591.
    [6]
    VinhVQ,Van AnhT,Gia TiênN,et al.Reconstruction of neck and face scar contractures using occipito-cervico-dorsal supercharged "super-thin flaps": a retrospective analysis of 82 cases in Vietnam[J].Burns,2018,44(2):462-467.DOI: 10.1016/j.burns.2017.07.020.
    [7]
    TsaiFC,YangJY,ChuangSS,et al.Combined method of free lateral leg perforator flap with cervicoplasty for reconstruction of anterior cervical scar contractures: a new flap[J].J Reconstr Microsurg,2002,18(3):185-190.DOI: 10.1055/s-2002-28470.
    [8]
    李青峰.关注面颈部重建治疗理念和技术的转变[J].中华整形外科杂志,2015,31(1):1-3.DOI: 10.3760/cma.j.issn.1009-4598.2015.01.001.
    [9]
    GaoY,LiH,GuB,et al.Postburn neck contracture: principles of reconstruction and a treatment algorithm[J].J Reconstr Microsurg,2018,34(7):514-521.DOI: 10.1055/s-0038-1641724.
    [10]
    陈建武,马显杰,郭树忠.以颈横动脉分支为蒂的锁骨上皮瓣和颈段皮支皮瓣的区别与联系[J].中华整形外科杂志,2018,34(3):239-242.DOI: 10.3760/cma.j.issn.1009-4598.2018.03.019.
    [11]
    赵思纯,王佳琦.扩张轴型皮瓣修复面颈部烧伤瘢痕的基础研究进展和临床应用[J].世界最新医学信息文摘,2018,18(30):45-47.DOI: 10.19613/j.cnki.1671-3141.2018.30.020.
    [12]
    韩军涛,王洪涛,李军,等.预扩张胸三角皮瓣修复面颈部烧伤瘢痕挛缩畸形的临床效果[J].中华医学美学美容杂志,2017,23(4):229-231.DOI: 10.3760/cma.j.issn.1671-0290.2017.04.005.
    [13]
    唐银科,楚菲菲,丁健科,等.颈部瘢痕挛缩治疗方案的优化选择及临床效果分析[J].中国美容整形外科杂志,2021,32(11):644-646,665.DOI: 10.3969/j.issn.1673-7040.2021.11.002.
    [14]
    OgawaR.Surgery for scar revision and reduction: from primary closure to flap surgery[J/OL].Burns Trauma,2019,7:7[2022-02-10]. https://pubmed.ncbi.nlm.nih.gov/30891462/.DOI: 10.1186/s41038-019-0144-5.
    [15]
    ZhangY,XiaoW,NgS,et al.Infrared thermography-guided designing and harvesting of pre-expanded pedicled flap for head and neck reconstruction[J].J Plast Reconstr Aesthet Surg,2021,74(9):2068-2075.DOI: 10.1016/j.bjps.2020.12.102.
    [16]
    中国整形美容协会瘢痕医学分会.瘢痕早期治疗全国专家共识(2020版)[J].中华烧伤杂志,2021,37(2):113-125.DOI: 10.3760/cma.j.cn501120-20200609-00300.
    [17]
    丁架月,朱薛锋,官剑.强脉冲光联合自黏性软聚硅酮敷料早期干预手术瘢痕的临床效果[J].中华医学美学美容杂志,2019,25(3):250-251.DOI: 10.3760/cma.j.issn.1671-0290.2019.03.022.
    [18]
    KimJC,KangSY,KimHO,et al.Efficacy of combined treatment with intense pulsed light and fractional erbium:YAG laser in scar prevention: a randomized split wound trial[J].Dermatol Ther,2021,34(5):e15061.DOI: 10.1111/dth.15061.
    [19]
    WangJ,WuJ,XuM,et al.A comprehensive reconstruction strategy for moderate to severe faciocervical scar contractures[J].Lasers Med Sci,2021,36(6):1275-1282.DOI: 10.1007/s10103-020-03178-w.
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