颞浅动脉顶支带蒂头皮瓣修复面部毁损性烧伤创面的临床效果

夏成德; 薛继东; 邢培朋; 狄海萍; 史继静; 张建; 曹大勇; 肖宏涛; 刘磊; 马超

doi:10.3760/cma.j.cn501225-20230312-00077

颞浅动脉顶支带蒂头皮瓣修复面部毁损性烧伤创面的临床效果

doi: 10.3760/cma.j.cn501225-20230312-00077

郑州市第一人民医院烧伤科，郑州　　450004

基金项目:

国家临床重点专科建设项目 2023-70

详细信息

通讯作者:
马超，Email：2273451508@qq.com

计量
- 文章访问数: 1782
- HTML全文浏览量: 57
- PDF下载量: 21
- 被引次数: 0
出版历程
- 收稿日期: 2023-03-12

Clinical effects of scalp flaps pedicled with superficial temporal artery parietal branch in repairing facial destructive burn wounds

Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China

Funds:

National Clinical Key Specialty Construction Project 2023-70

More Information

Corresponding author: Ma Chao, Email: 2273451508@qq.com

摘要

摘要: 目的探讨采用颞浅动脉顶支带蒂头皮瓣修复面部毁损性烧伤创面的临床效果。方法采用回顾性观察性研究方法。2016年1月—2021年12月，郑州市第一人民医院收治15例符合入选标准的面部毁损性烧伤患者，其中男11例、女4例，年龄22~79岁。2例患者合并单侧眼球毁损性烧伤，2例患者合并单侧耳郭缺损，8例患者合并唇及面颊部缺损，3例患者合并唇和面颊部及单侧鼻翼缺损。烧伤创面面积为9 cm×6 cm~13 cm×10 cm，设计并切取面积为10 cm×7 cm~15 cm×11 cm的颞浅动脉顶支带蒂头皮瓣转移修复烧伤创面，移植中厚头皮片修复供瓣区继发创面。根据患者需求，于皮瓣完全成活后2周，应用激光脱去面部移植皮瓣部位生长的毛发；或于原发创面修复术后3个月，采用扩张头皮瓣治疗头部供瓣区继发的秃发。记录原发创面修复术后皮瓣/皮片成活情况、皮瓣供受区创面愈合情况；随访时观察皮瓣外观及缝合口瘢痕增生情况、面部功能部位修复效果、激光脱毛及供瓣区继发秃发治疗效果，询问患者对整体修复效果的满意度。结果原发创面修复术后，烧伤创面移植的皮瓣和供瓣区继发创面移植的皮片全部成活，皮瓣供受区创面愈合良好。原发创面修复术后随访3~18个月，皮瓣色泽、质地、厚度等与面部正常皮肤基本一致，缝合口瘢痕轻微。11例合并唇部缺损者，口腔完整性及张口、闭口功能得以恢复，张口度2.0~2.5 cm，无小口畸形，均可进行基本的语言交流，其中8例患者可进普食，3例患者可进软食；2例合并单侧眼球毁损性烧伤者，创面得以修复；2例合并耳郭缺损者，创面得以修复，外耳道正常；3例合并单侧鼻翼缺损者，鼻部外形欠佳，鼻孔缩小。8例患者面部移植皮瓣部位行激光脱毛治疗后未再长毛发，采用扩张头皮瓣成功治疗5例患者头部供瓣区继发的秃发。患者均对整体修复效果感到满意。结论颞浅动脉顶支带蒂头皮瓣血供丰富，适用于修复面部毁损性烧伤创面，转移方便，能使受区恢复较好的外观与功能，皮瓣供区损伤小，值得临床推广。
- 烧伤 /
- 面部 /
- 外科皮瓣 /
- 皮肤缺损 /
- 颞浅动脉顶支
Abstract: Objective To explore the clinical effects of scalp flaps pedicled with superficial temporal artery parietal branch in repairing facial destructive burn wounds. Methods A retrospective observational study was conducted. From January 2016 to December 2021, 15 patients with facial destructive burns who met the inclusion criteria were admitted to Zhengzhou First People's Hospital, including 11 males and 4 females, aged 22 to 79 years. Two patients were complicated with unilateral eyeball destructive burns, two patients were complicated with unilateral auricle defects, eight patients were complicated with lip and cheek defects, and three patients were complicated with lip, cheek, and unilateral nasal alar defects. The burn wound areas ranged from 9 cm×6 cm to 13 cm×10 cm. The scalp flaps pedicled with superficial temporal artery parietal branch, with the area of 10 cm×7 cm to 15 cm×11 cm, were designed, excised, and transferred for repairing burn wounds. The secondary wounds at the donor sites were repaired with medium-thickness scalp grafts. According to patient's needs, the hairs grew at the facial transplanted flap were removed by laser at 2 weeks after the flap was completely viable, or the expanded scalp flap was used to treat the secondary alopecia in the flap donor area of the head at 3 months after the primary wound repair. The survival of the flap/skin graft and the wound healing of the donor and recipient areas after the primary wound repair were recorded. During the follow-up, the appearance of the flap, the scar hyperplasia at the suture site, the repair effect of facial functional parts, the treatment effects of laser hair removal and secondary alopecia treatment at the flap donor site were observed; the patient's satisfaction with the overall repair effect was inquired. Results After the primary wound repair, all the flaps transplanted to the burn wounds and the skin grafts transplanted to the secondary wounds of the flap donor sites survived well, and the wounds at the donor and recipient sites of flap healed well. The color, texture, and thickness of flap were basically the same as those of normal facial skin, and the scar at the suture site was slight during 3 to 18 months of follow-up period after the primary wound repair. In 11 patients complicated with lip defects, the oral integrity, and the opening and closing functions of mouth were restored with the mouth opening being 2.0-2.5 cm and no microstomia; all the patients could carry out basic language communication, 8 of them could take regular food, and 3 of them could take soft food. The wounds in two patients with unilateral eyeball destructive burns were repaired. In 2 patients complicated with auricle defects, the wounds were repaired, and the external auditory canals were normal. In 3 patients complicated with unilateral nasal alar defects, their noses had poor appearance with reduced nostrils. No hair growth was observed in the facial flap sites after treatment of laser hair removal in 8 patients. Five patients were successfully treated with expanded scalp flaps for secondary alopecia in the flap donor area of the head. The patients were all satisfied with the overall repair effect. Conclusions The scalp flap pedicled with superficial temporal artery parietal branch has abundant blood supply and is suitable for repairing the wounds in facial destructive burns. It is easy to transfer and can better restore the appearance and function of the recipient area with minimal damage to the flap donor area, which is worthy of clinical promotion.
- Burns /
- Face /
- Surgical flaps /
- Skin defect /
- Superficial temporal artery parietal branch
夏成徳、薛继东、狄海萍：手术设计和操作、论文撰写、病历资料整理及分析；邢培朋、史继静、张建、曹大勇、肖宏涛、刘磊：患者管理、手术操作、资料收集；马超：论文修改

所有作者均声明不存在利益冲突

HTML全文

参考文献(25)

[1]	RabbaniCC,HwangMS,ByrnePJ,et al.Management of large facial defects[J].Facial Plast Surg,2020,36(2):148-157.DOI: 10.1055/s-0040-1709179.
[2]	黄昕,昝涛.头面部严重毁损的治疗进展[J].上海交通大学学报(医学版),2017,37(9):1303-1307.DOI: 10.3969/j.issn.1674-8115.2017.09.020.
[3]	张丕红.毁损伤的成因与评估及其修复策略优化探讨[J].中华烧伤杂志,2021,37(7):601-605.DOI: 10.3760/cma.j.cn501120-20210119-00029.
[4]	夏成德,薛继东,狄海萍,等.CT血管造影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[J].中华烧伤杂志,2018,34(10):677-682.DOI: 10.3760/cma.j.issn.1009-2587.2018.10.006.
[5]	SunH,LiuY,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.
[6]	JiangW,ChenL,JiaL,et al.Corrective strategies for poor appearance after tissue expansion for temporal and sideburn cicatricial alopecia[J].J Cosmet Dermatol,2021,20(12):4001-4004.DOI: 10.1111/jocd.14067.
[7]	GaoB,XiaoK,ZhuH,et al.An algorithm for using expanded cervical flaps to resurface facial defects based on five different methods[J].Burns,2016,42(8):1867-1874.DOI: 10.1016/j.burns.2016.06.006.
[8]	夏成德,薛继东,狄海萍,等.额颞部扩张皮瓣修复面颈部瘢痕挛缩畸形[J].中华整形外科杂志,2019,35(5):430-435.DOI: 10.3760/cma.j.issn.1009-4598.2019.05.003.
[9]	张蕾,张杰,孟彦,等.游离股前外侧穿支皮瓣修复上颌复合组织缺损的临床研究[J].肿瘤研究与临床,2018,30(11):753-756.DOI: 10.3760/cma.j.issn.1006-9801.2018.11.008.
[10]	MoonP,PatelJV,MishraG,et al.Functional reconstruction of through and through cheek defect with free composite bi-pedalled anterolateral thigh flap[J].Indian J Otolaryngol Head Neck Surg,2023,75(2):649-653.DOI: 10.1007/s12070-022-03416-3.
[11]	尹鑫海,赵科,罗洪,等.游离背阔肌皮瓣修复颌面部软组织缺损[J].遵义医学院学报,2010,33(4):373-374,376.DOI: 10.3969/j.issn.1000-2715.2010.04.020.
[12]	XiaoY,XiaoH,WanH,et al.Pre-expanded latissimus dorsi myocutaneous flap for total scalp defect reconstruction[J].J Craniofac Surg,2020,31(2):e151-e153.DOI: 10.1097/SCS.0000000000006084.
[13]	Piotrowska-SewerynA,OpyrchalJ,KrakowczykL.Reconstruction of nose and adjacent facial units with chimeric flap combined of auricular free flap and radial forearm free flap[J].J Craniofac Surg,2022,33(3):e320-e322.DOI: 10.1097/SCS.0000000000008216.
[14]	刘亮,张凯,李建成,等.个性化前臂皮瓣在口腔颌面部缺损修复的临床观察[J].中华显微外科杂志,2017,40(1):30-34.DOI: 10.3760/cma.j.issn.1001-2036.2017.01.010.
[15]	李建成,宋培军,杨东昆,等.小腿后外侧腓动脉双叶穿支游离皮瓣修复口腔颌面部恶性肿瘤术后面部洞穿性缺损[J].中华显微外科杂志,2019,42(1):26-31.DOI: 10.3760/cma.j.issn.1001-2036.2019.01.008.
[16]	夏成德,狄海萍,薛继东,等.游离股前外侧或小腿内侧皮瓣修复患者颜面部严重烧伤的效果[J].中华烧伤杂志,2019,35(7):512-516.DOI: 10.3760/cma.j.issn.1009-2587.2019.07.007.
[17]	张凯,王栋,高廷益,等.彩色多普勒超声辅助下腹部浅动脉供血皮瓣修复颌面部软组织缺损[J].中华整形外科杂志,2019,35(12):1200-1204.DOI: 10.3760/cma.j.issn.1009-4598.2019.12.007.
[18]	王宏伟,郭兵,马春跃,等.腹壁浅动脉穿支皮瓣修复口腔颌面部软组织缺损3例报道[J].中国口腔颌面外科杂志,2018,16(1):78-83.DOI: 10.19438/j.cjoms.2018.01.017.
[19]	ElbanobyTM,ZidanSM,ElbatawyAM,et al.Superficial temporal artery flap for reconstruction of complex facial defects: a new algorithm[J].Arch Plast Surg,2018,45(2):118-127.DOI: 10.5999/aps.2017.00360.
[20]	Al-QattanMM.One pedicled superficial temporal artery hair-bearing flap to reconstruct three different anatomical areas of the burnt face: a personal technique[J].Ann Plast Surg,2021,86(2):159-161.DOI: 10.1097/SAP.0000000000002613.
[21]	LeiB,ZhongY,ChenZ,et al.Application of composite tissue flap pedicled with superficial temporal artery and its branches in the repair of various maxillofacial defects[J].J Craniofac Surg,2023,34(2):515-519.DOI: 10.1097/SCS.0000000000009020.
[22]	EyraudQ,GrivetD,GleizalA,et al.Superficial temporal artery perforator flap for reconstruction of periorbital and eyelid defects, a variant of the classic flaps dissected in perforator flap[J].J Stomatol Oral Maxillofac Surg,2021,122(5):482-486.DOI: 10.1016/j.jormas.2020.08.009.
[23]	BinhimdU,AlkaabiSA,AlsabriGA,et al.Superficial temporal artery capillary perforator-based island flap for conchal bowl and external auditory canal reconstruction[J].Ann Chir Plast Esthet,2022,67(1):42-48.DOI: 10.1016/j.anplas.2021.11.005.
[24]	侯春林,顾玉东.皮瓣外科学[M].2版.上海:上海科学技术出版社,2013:255-272
[25]	夏成德,薛继东,狄海萍,等.额顶部跨中线轴型扩张皮瓣单蒂转移整复面颈部大面积瘢痕畸形的临床效果[J].中华烧伤杂志,2020,36(9):838-844.DOI: 10.3760/cma.j.cn501120-20200311-00149.

下载: 全尺寸图片幻灯片

1 左侧颞浅动脉顶支带蒂头皮瓣修复例1患者一氧化碳中毒后左面部毁损性烧伤创面的效果。1A.术前，左侧面部软组织广泛坏死，形成黑色焦痂；1B.术中切除坏死组织后上下唇部分缺损，左侧颧骨和下颌骨外露；1C.术中设计面积为15 cm×11 cm的左侧颞浅动脉顶支带蒂头皮瓣；1D.术中切取皮瓣后即刻；1E.术中于口裂处切开皮瓣，重建上下唇，左下唇缺损部位皮瓣的肉面移植头皮，形成口腔衬里；1F.皮瓣转移术后即刻，血运良好；1G、1H.分别为术后3个月闭口和张口情况，口腔功能恢复好，面部外形较佳

下载: 全尺寸图片幻灯片

2 左侧颞浅动脉顶支带蒂头皮瓣修复例2患者一氧化碳中毒后左面部毁损性烧伤创面的效果。2A.术前，左侧中下面部形成坏死焦痂，部分已溶脱；2B.术中彻底清除坏死组织后，上下唇部分缺损，下颌骨外露；2C.术中设计面积为16 cm×9 cm的左侧颞浅动脉顶支带蒂头皮瓣；2D.术中切取皮瓣后即刻；2E.于修复左下唇缺损部位相应皮瓣肉面预先移植头皮，形成口腔衬里后即刻；2F.术后10 d，掀起皮瓣并转移至面部创面，于口裂处切开，重建左侧上下唇；2G.原发创面修复术后18个月复查正面观，创面愈合良好；2H.原发创面修复术后18个月复查左侧位观，面部外形较佳

下载: 全尺寸图片幻灯片