Email Alerts
RSS
Volume 39 Issue 3
Mar.  2023
Turn off MathJax
Article Contents
Article Navigation >  CHINESE JOURNAL OF BURNS AND WOUNDS  > 2023  >  39(3): 241-247
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.
shu

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

doi: 10.3760/cma.j.cn501225-20220123-00012
  • 1.

    Department of Plastic, AestheticMaxillofacial Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China

  • 2.

    Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital, Air Force Medical University, Xi'an 710032, China

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
  • Corresponding author: Shu Maoguo, Email: shumaoguo@163.com
  • Received Date: 2022-01-23
    Abstract
  •   Objective   To explore the clinical effects of free pre-expanded deltopectoral flap transfer in facial scar reconstruction by selecting appropriate internal thoracic artery perforator as the pedicle through preoperative color Doppler ultrasonic vascular assessment.   Methods   A retrospective observational study was conducted. From September 2017 to March 2021, 11 patients with facial scar who met the inclusion criteria were admitted to the First Affiliated Hospital of Xi'an Jiaotong University, including 6 males and 5 females, aged 16-58 (31±12) years. The scar with area ranging from 7 cm×5 cm to 14 cm×9 cm was reconstructed by free pre-expanded internal thoracic artery perforator pedicled deltopectoral flap transfer. The operation was performed in 2 or 3 stages. Before operation, color Doppler ultrasonography was performed to evaluate the internal thoracic artery perforator. In the first stage, skin and soft tissue expander (hereinafter referred to as expander) implantation was performed, and a cylindrical expander with rated capacity of 400 to 600 mL was placed in the chest wall. The expansion time was 3 to 4 months, and the water injection volume reached 1.2-1.5 times of the rated capacity of expander. In the second stage, scar excision+free pre-expanded deltopectoral flap transfer was performed, with harvested flap area ranging from 9 cm×7 cm to 16 cm×10 cm. The vascular pedicle of flap (intercostal perforator of internal thoracic artery) was anastomosed end-to-end to the facial artery and vein or superficial temporal artery and vein. The wound in donor site was closed directly. Third stage operation thinning was performed at 3-6 months after the second stage operation in 5 patients because of bloated flap pedicle. At 6 months after the last operation, the flap survival and complications were recorded, the sensation of flap was evaluated by Semmes-Weinstein monofilament test, the color of flap was evaluated by color contrast of the flap to surrounding normal skin, and the curative effect satisfaction degree of patients was evaluated by 5-grade Likert scale.   Results   At 6 months after the last operation, all the flaps of 11 patients survived well. One patient experienced venous congestion after flap transplantation, but the flap survived after re-anastomosis. One patient experienced hematoma after the first stage operation of expander implantation, but the rest treatment was not influenced after hematoma removal. No complications such as infection or expander exposure occurred in any patient. At 6 months after the last operation, the sensation of flap of patient was as follows: 9 cases recovered to protective sensation decrease or better, 1 case had protective sensation defect, and 1 case only had deep touch and pressure sensation; the color of flap of patient was as follows: 3 cases were very close to the color of surrounding normal skin, 6 cases were close to the color of surrounding normal skin, and 2 cases were different to the color of surrounding normal skin; the curative effect satisfaction degree of patients was as follows: 2 patients were very satisfied, 6 patients were satisfied, 2 patients were somewhat satisfied, and 1 patient was a little not satisfied.   Conclusions   The large area facial scar can be treated safely and effectively by free pre-expanded deltopectoral flap with appropriate single internal thoracic artery perforator as vascular pedicle selected through vascular assessment by color Doppler ultrasonography before operation. After operation, the color of flap of patients is close to the surrounding normal skin and the sensation of flap can be partially recovered, with high curative effect satisfaction degree of patients.

     

    • FullText(HTML)
  • loading
    • References(36)
  • [1]
    VincentAG, KadakiaS, BarkerJ, et al. Management of facial scars[J]. Facial Plast Surg, 2019,35(6):666-671. DOI: 10.1055/s-0039-3401642.
    [2]
    谢卫国. 瘢痕的激光及相关光电治疗前景值得期待[J]. 中华烧伤杂志, 2018,34(9):598-602. DOI: 10.3760/cma.j.issn.1009-2587.2018.09.008.
    [3]
    ShokriT, SmithJ, DucicY. Paradigms in complex facial scar management[J]. Semin Plast Surg, 2020,34(4):305-313. DOI: 10.1055/s-0040-1721768.
    [4]
    GandolfiS, CarloniR, BertheuilN, et al. Assessment of quality-of-life in patients with face-and-neck burns: the Burn-Specific Health Scale for Face and Neck (BSHS-FN)[J]. Burns, 2018,44(6):1602-1609. DOI: 10.1016/j.burns.2018.03.002.
    [5]
    王占统, 董琛, 唐银科, 等. 预扩张胸三角皮瓣修复面颈部病损的临床效果[J]. 中华烧伤杂志, 2020,36(5):363-369. DOI: 10.3760/cma.j.cn501120-20200113-00019.
    [6]
    MaXJ, LiY, LiWY, et al. Reconstruction of large postburn facial-scalp scars by expanded pedicled deltopectoral flap and random scalp flap: technique improvements to enlarge the reconstructive territory[J]. J Craniofac Surg, 2017,28(6):1526-1530. DOI: 10.1097/SCS.0000000000003902.
    [7]
    DingJK, LiY, LiWY, et al. Use of expanded deltopectoral skin flaps for facial reconstruction after sizeable benign tumor resections[J]. Am J Transl Res, 2018,10(7):2158-2163.
    [8]
    马显杰,夏炜,郑岩,等.扩张后胸三角皮瓣修复面颈部瘢痕[J].中华烧伤杂志,2008,24(3):207-209.DOI: 10.3760/cma.j.issn.1009-2587.2008.03.013.
    [9]
    LiuC, HaoD, LiY, et al. Repair of facial scars using free and pedicle-expanded deltopectoral flaps[J]. Br J Oral Maxillofac Surg, 2021,59(6):710-715. DOI: 10.1016/j.bjoms.2020.12.022.
    [10]
    AngrigianiC, RancatiA, VarelaI, et al. The deltopectoral/internal mammary artery perforator flap revisited: design variations based on cadaveric and clinical investigation[J]. Ann Plast Surg, 2022,88(1):88-92. DOI: 10.1097/SAP.0000000000002863.
    [11]
    王占统,余州,丁健科,等.预扩张胸三角皮瓣修复面颈部瘢痕的效果评价[J].中华整形外科杂志,2019,35(10):953-960.DOI: 10.3760/cma.j.issn.1009-4598.2019.10.002.
    [12]
    侯健, 宋慧锋, 陈保国, 等. 预扩张颈横动脉前穿支皮瓣与预扩张胸部随意皮瓣接力整复大面积面颈部瘢痕的临床效果[J]. 中华烧伤杂志, 2021,37(4):350-355. DOI: 10.3760/cma.j.cn501120-20201023-00445.
    [13]
    IbrahimA, AtiyehB, KaramiR, et al. The deltopectoral flap revisited: the internal mammary artery perforator flap[J]. J Craniofac Surg, 2016,27(2): e189-192. DOI: 10.1097/SCS.0000000000002445.
    [14]
    AldelaimiTN,KhalilAA.Reconstruction of facial defect using deltopectoral flap[J].J Craniofac Surg,2015,26(8):e786-788.DOI: 10.1097/SCS.0000000000002056.
    [15]
    SunHY,LiuYC,YaoP,et al.Prefabricated expanded flap combined with expanded scalp flap for total face resurfacing[J].Ann Plast Surg,2021,86(3S Suppl 2):S265-268.DOI: 10.1097/SAP.0000000000002635.
    [16]
    BakamjianV. A two-stage method of pharyngoesophageal reconstruction with a primary pectoral skin flap[J]. Plast Reconstr Surg, 1965,36:173-184. DOI: 10.1097/00006534-196508000-00004.
    [17]
    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.
    [18]
    马显杰, 丁健科. 皮肤软组织扩张术在儿童体表病损修复中的应用[J]. 中华烧伤与创面修复杂志, 2022, 38(4): 301-305. DOI: 10.3760/cma.j.cn501120-20211019-00359.
    [19]
    WangZT,DingJK,TangYK,et al.Application of various methods to evaluate the postoperative characteristics of expanded pedicled deltopectoral flap for large facial scars[J].J Craniofac Surg,2022,33(4):1130-1135.DOI: 10.1097/SCS.0000000000008221.
    [20]
    MinPR, LiJ, BrunettiB, et al. Pre-expanded bipedicled visor flap: an ideal option for the reconstruction of upper and lower lip defects postburn in Asian males[J/OL]. Burns Trauma, 2020,8:tkaa005[2022-01-23]. https://pubmed.ncbi.nlm.nih.gov/32341918/. DOI: 10.1093/burnst/tkaa005.
    [21]
    MaXJ, LiY, LiWY, et al. Reconstruction of facial-cervical scars with pedicled expanded deltopectoral flap[J]. J Craniofac Surg, 2017, 28(6):1554-1558. DOI: 10.1097/SCS.0000000000003901.
    [22]
    IidaT, YoshimatsuH. Anatomical study and clinical application of free thoracoacromial artery true-perforator flap for reconstruction of the face[J]. J Craniofac Surg, 2019,30(1):205-207. DOI: 10.1097/SCS.0000000000004968.
    [23]
    刘云菡, 黄昕, 李海洲, 等. 扩张的胸廓内动脉穿支皮瓣联合血管增压在面颈部瘢痕整复中的临床应用[J]. 中华烧伤与创面修复杂志, 2022,38(4):313-320. DOI: 10.3760/cma.j.cn501120-20210928-00334.
    [24]
    郭鱼, 岑瑛, 高智雍, 等. 扩张胸三角皮瓣修复头面部皮肤软组织缺损的效果分析[J]. 中国美容医学, 2019, 28(4):135-138.
    [25]
    KerdoudO, AlouaR, SlimaniF. The deltopectoral flap in full-thickness cheek defect: a case report[J]. Ann Med Surg (Lond), 2021,62(1):119-122. DOI: 10.1016/j.amsu.2021.01.025.
    [26]
    SongBQ, ZhaoJH, GuoSZ, et al. Repair of facial scars by the free expanded deltopectoral flap[J]. Plast Reconstr Surg, 2013,131(2):200e-208e. DOI: 10.1097/PRS.0b013e3182789c02.
    [27]
    ChanRCL, ChanJYW. Deltopectoral flap in the era of microsurgery[J]. Surg Res Pract, 2014,2014:420892. DOI: 10.1155/2014/420892.
    [28]
    刘超华, 李杨, 肖博, 等. 扩张后胸三角游离皮瓣修复面部大中面积皮肤软组织缺损[J]. 中华整形外科杂志, 2018,34 (12):996-999. DOI: 10.3760/cma.j.issn.1009-4598.2018.12.003.
    [29]
    SwendseidB, StewartM, MastrolonardoE, et al. Technical considerations in pedicle management in upper and midfacial free flap reconstruction[J]. Laryngoscope, 2021,131(11):2465-2470. DOI: 10.1002/lary.29708.
    [30]
    GréantE,HaesendonckGV,FarisC.A buccal space approach for midface free flap reconstruction[J].Facial Plast Surg,2022,38(2):214-217.DOI: 10.1055/s-0041-1742133.
    [31]
    朱雄翔, 郑朝, 张冬梅, 等. 扩张穿支皮瓣游离移植治疗儿童严重瘢痕挛缩畸形的效果[J]. 中华烧伤杂志, 2019,35(6):405-409. DOI: 10.3760/cma.j.issn.1009-2587.2019.06.002.
    [32]
    MassarelliO, VairaLA, BiglioA, et al. Sensory recovery of myomucosal flap oral cavity reconstructions[J]. Head Neck, 2018,40(3):467-474. DOI: 10.1002/hed.25000.
    [33]
    KarmakarS, MishraB, SinghAK, et al. A study of the pattern of sensory return in various flaps in different body areas[J]. J Plast Reconstr Aesthet Surg, 2022,75(3):1041-1047. DOI: 10.1016/j.bjps.2021.09.044.
    [34]
    马显杰,李威扬,刘超华,等.面部烧伤后瘢痕的美学整复策略及疗效[J].中华烧伤杂志,2016,32(8):469-473.DOI: 10.3760/cma.j.issn.1009-2587.2016.08.006.
    [35]
    AbubakarML, IbrahimA. Management of facial burns: an update[J]. Curr Opin Otolaryngol Head Neck Surg, 2021,29(4):299-303. DOI: 10.1097/MOO.0000000000000723.
    [36]
    CassND, TerellaAM. Reconstruction of the cheek[J]. Facial Plast Surg Clin North Am, 2019,27(1):55-66. DOI: 10.1016/j.fsc.2018.08.007.
    • Relative Articles
    • Supplements(0)
    • Cited By
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(3)

    Get Citation
    PDF
    XML

    Article Metrics

    Article views (1907) PDF downloads(33) Cited by()
    Proportional views
    Related

    Copyright © Chinese Journal of Burns京ICP备07035254号-14

    E-mail：shaoshangzazhi@163.com

    Website：https://zhsszz.xml-journal.net/

    Supported by: Beijing Renhe Information Technology Co. Ltd    

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return