扩张胸外侧动脉穿支皮瓣整复未成年女性乳房烧伤后瘢痕挛缩畸形的效果

刘昌玲; 张志; 李罡; 黄峻; 胡逸萍; 汤文彬; 盛聪聪

doi:10.3760/cma.j.cn501225-20241230-00514

扩张胸外侧动脉穿支皮瓣整复未成年女性乳房烧伤后瘢痕挛缩畸形的效果

doi: 10.3760/cma.j.cn501225-20241230-00514

暨南大学附属广州红十字会医院烧伤整形科,广州　　510220

基金项目:

广州市科技局项目 2023A03J0523, 2024A03J0570

广州市卫生健康科技项目一般引导项目 20241A011023

详细信息

通讯作者:
张志,Email：zhangzhicc48@163.com

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出版历程
- 收稿日期: 2024-12-30

Effects of the expanded lateral thoracic artery perforator flap in the reconstruction of breast scar contracture deformity after burns in minor females

Department of Burns and Plastic Surgery, Guangzhou Red Cross Hospital, Jinan University, Guangzhou 510220, China

Funds:

Program of Guangzhou Science and Technology Bureau 2023A03J0523, 2024A03J0570

General Guidance Project of Guangzhou Health Science and Technology Project 20241A011023

More Information

Corresponding author: Zhang Zhi, Email: zhangzhicc48@163.com

摘要

摘要: 目的探讨采用扩张胸外侧动脉穿支皮瓣整复未成年女性乳房烧伤后瘢痕挛缩畸形的效果。方法该研究为回顾性观察性研究。2018年7月—2023年10月,暨南大学附属广州红十字会医院烧伤整形科收治8例符合入选标准的乳房烧伤后瘢痕挛缩畸形的女性患儿,年龄4~12岁。Ⅰ期行皮肤软组织扩张器（以下简称扩张器）置入术,Ⅱ期手术切除及松解挛缩瘢痕,瘢痕切除后所形成的创面大小为9 cm×8 cm~15 cm×10 cm,设计、转移扩张胸外侧动脉穿支皮瓣修复创面,切取的皮瓣大小为10 cm×9 cm~16 cm×11 cm。将供瓣区创面直接缝合。Ⅰ期术后观察切口感染、血肿、扩张器外露等并发症发生情况。Ⅱ期术后,观察皮瓣成活情况、皮瓣供区创面愈合情况。Ⅱ期术后1年随访时,根据女性青春期乳腺发育的tanner分期表现评定乳房发育情况,采用乳房术后美学效果评价标准对患侧乳房美学效果进行评定,采用温哥华瘢痕量表（VSS）对皮瓣供区及受区瘢痕情况进行评分,采用自制量表调查患儿家属对手术效果的满意度。结果 Ⅰ期术后,8例患儿均未发生切口感染、血肿、扩张器外露等并发症。Ⅱ期术后,仅有1例患儿皮瓣远端有大小约2 cm×1 cm组织坏死,经换药后愈合；其余患儿皮瓣血运良好、质地柔软、厚度适中,颜色与受区皮肤接近。皮瓣供区创面均愈合良好。Ⅱ期术后1年随访时,7例患儿乳房发育正常,乳房体积、高度、形态均与健侧几乎相同或接近,美学效果均为一级；1例患儿乳房尚未发育,未评价这些指标。8例患儿乳头乳晕复合体位置与健侧几乎相同或接近,转移皮瓣修复的乳房部分的皮肤色泽、完整性、质地、弹性与健侧接近,美学效果均为一级。5例患儿乳头形态、乳晕形态因原本存在的瘢痕而与健侧不一致,美学效果均为二级；其余3例患儿乳头形态、乳晕形态与健侧一致,美学效果均为一级。皮瓣受区瘢痕VSS评分为2~5分,皮瓣供区瘢痕VSS评分为1~3分。7名患儿家属对手术效果表示满意,1名患儿家属对手术效果表示基本满意。结论对于未成年女性乳房烧伤后瘢痕挛缩畸形,在青春期前采用扩张胸外侧动脉穿支皮瓣进行整复,术后并发症少,乳房外形较佳,供瓣区瘢痕隐蔽,有利于青春期乳房正常发育,是治疗未成年女性乳房烧伤后瘢痕挛缩畸形安全有效的方法之一。
- 瘢痕 /
- 烧伤 /
- 扩张术 /
- 穿支皮瓣 /
- 未成年人 /
- 乳房 /
- 胸外侧皮瓣
Abstract: Objective To investigate the effects of the expanded lateral thoracic artery perforator flap in the reconstruction of breast scar contracture deformity after burns in minor females. Methods The study was a retrospective observational study. From July 2018 to October 2023, 8 female children aged 4 to 12 years and with breast scar contracture deformity after burns, who met the inclusion criteria, were admitted to the Department of Burns and Plastic Surgery of Guangzhou Red Cross Hospital of Jinan University. The skin and soft tissue expander (hereinafter referred to as expander) was placed in the first stage. The contracture scar was removed and released in the second stage, and the wound formed after the scar was removed measured between 9 cm×8 cm and 15 cm×10 cm. The expanded lateral thoracic artery perforator flap was designed and transferred to repair the wound with resected flap area of 10 cm×9 cm to 16 cm×11 cm, and the wound at the flap donor area was directly sutured. The complications such as incision infection, hematoma, and expander exposure were observed after stage Ⅰ surgery. After stage Ⅱ surgery, the survival of the flap and the wound healing at the flap donor area were observed. During the 1-year follow-up after the stage Ⅱ surgery, the breast development was evaluated according to tanner staging performance of female pubertal breast development, the aesthetic effect of the affected breast was evaluated by using the aesthetic effect evaluation standard after breast surgery, the Vancouver scar scale (VSS) was used to score the scar condition at the flap donor and recipient areas, and the satisfaction of the children's families with the surgical outcomes was investigated by using a self-made scale. Results After stage Ⅰ surgery, no incision infection, hematoma, expander exposure, or other complications occurred in 8 children. After stage Ⅱ surgery, only one child had tissue necrosis at the distal end of the flap with a size of about 2 cm×1 cm, which healed after dressing change, and the flap in other children had good blood supply, soft texture, moderate thickness, and similar color to the skin at the recipient area. The wounds at all flap donor areas healed well. During the 1-year follow-up after stage Ⅱ surgery, 7 children had normal breast development, with their breast volume, height, and shape being almost the same as or similar to the healthy side, with the aesthetic effect of all being grade Ⅰ; the breast in one child had not yet developed, and these indicators were not evaluated. The locations of nipple areola complex in 8 children were almost the same as or similar to those in the healthy side, and their skin color, integrity, texture, and elasticity of the partial breast repaired by the transferred flap were similar to those in the healthy side, with the aesthetic effect of all being grade Ⅰ. The shapes of nipple and areola in 5 children were inconsistent with those in the healthy side because of the original scar, with the aesthetic effect of all being grade Ⅱ, and the shapes of nipple and areola in the other 3 children were consistent with those in the healthy side, with the aesthetic effect of all being grade Ⅰ. The VSS score of the scar at the flap recipient area was 2-5, and the VSS score of the scar at the flap donor area was 1-3. Seven children's families were satisfied with the surgical effect, and one child's family was basically satisfied with the surgical effect. Conclusions For the breast scar contracture deformity of minor females after burns, the expanded lateral thoracic artery perforator flap is used for reconstruction before puberty, which results in fewer postoperative complications, good breast shape, and hidden scar at the flap donor area. It is beneficial for the normal development of adolescent breasts, and is one of the safe and effective methods for the treatment of breast scar contracture deformity in minor females after burns.
- Cicatrix /
- Burns /
- Dilatation /
- Perforator flap /
- Minors /
- Breast /
- Lateral thoracic flap
刘昌玲：参与患者管理、实施手术、文章撰写；张志：指导手术的设计与实施过程、指导文章撰写、论文修改；李罡、黄峻、胡逸萍、汤文彬：患者管理、实施手术、收集数据；盛聪聪：数据统计、病例图片编辑修改

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图 1 采用扩张胸外侧动脉穿支皮瓣整复未成年女性左侧乳房瘢痕挛缩畸形的效果。1A.左侧躯干置入皮肤软组织扩张器后3个月,注水完成；1B.Ⅱ期术前,根据胸乳间距线以及乳头间距线,在第4、5肋间水平画出患侧乳头大致的范围后,参考女性青春期乳腺发育的tanner分期表现,结合患儿年龄,在B超引导下找到瘢痕下方尚未发育乳腺组织的大致范围并标记；1C.Ⅱ期术前,根据彩色多普勒超声探查情况,标记胸外侧动脉穿支走行；1D.Ⅱ期术中,切除松解左侧乳房挛缩的瘢痕,转移扩张皮瓣修复创面后；1E.Ⅱ期术中,保留患侧乳头乳晕及周围直径约1 cm组织,将其从皮瓣合适的位置穿出并缝合固定,供瓣区创面减张缝合后即刻；1F.Ⅱ期术后1周,皮瓣血运良好、厚度适中,颜色与受区皮肤接近,供瓣区创面愈合良好；1G、1H.分别为Ⅱ期术后1年随访时正面观、侧面观,乳房发育正常,双侧乳房、乳头位置基本对称,供瓣区仅遗留线状瘢痕

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