扩张颞浅动脉双蒂皮瓣整复中下面部烧伤后瘢痕挛缩畸形的临床效果

夏成德; 薛继东; 狄海萍; 邢培朋; 郭海娜; 赵孝开; 谢江帆; 韩大伟; 王迎秋

doi:10.3760/cma.j.cn501225-20260103-00001

扩张颞浅动脉双蒂皮瓣整复中下面部烧伤后瘢痕挛缩畸形的临床效果

doi: 10.3760/cma.j.cn501225-20260103-00001

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:
王迎秋,Email：2273451508@qq.com

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出版历程
- 收稿日期: 2026-01-03
- 网络出版日期: 2026-03-30

Clinical effects of expanded superficial temporal artery double-pedicled flaps in reconstructing scar contracture deformities after burns in the mid and lower face

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

Funds:

National Clinical Key Specialty Construction Project 2023-70

More Information

Corresponding author: Wang Yingqiu, Email: 2273451508@qq.com

摘要

摘要: 目的探讨应用扩张颞浅动脉双蒂皮瓣整复中下面部烧伤后瘢痕挛缩畸形的临床效果。方法该研究为回顾性病例系列研究。2020年1月—2025年1月,郑州市第一人民医院收治20例符合入选标准的中下面部烧伤后瘢痕挛缩畸形男性患者,年龄15~56岁,病程为1~10年,其中16例患者存在上下唇瘢痕挛缩伴小口畸形及唇外翻,其张口度为2.0~2.5 cm。应用扩张颞浅动脉双蒂皮瓣整复瘢痕挛缩畸形,手术分3期进行。Ⅰ期于头顶部置入1个额定容量为500~900 mL的圆柱形皮肤软组织扩张器（以下简称扩张器）,如有需要,另在颞部（单侧或双侧）置入1个额定容量为100~200 mL的扩张器,术后规律注水扩张,使最终注水量达扩张器额定容量的2~3倍。Ⅰ期术后5~6个月行Ⅱ期手术,采用以双侧颞浅动脉顶支或额支为蒂的扩张皮瓣（面积为35 cm×11 cm~54 cm×19 cm）修复瘢痕切除与挛缩松解后形成的创面。对于同时累及上下唇的瘢痕挛缩,在皮瓣对应于正常口裂的位置做一约6 cm横行切口,形成新口裂并恢复口角正常位置,将作为上唇部的皮瓣的宽度调整为2.5~3.0 cm。将供区创面直接拉拢缝合,对于闭合不全者采用瘢痕皮片暂时覆盖。Ⅱ期术后3~4周行Ⅲ期手术,包括皮瓣断蒂及蒂部修整复位等。记录皮瓣扩张情况,Ⅱ期术后皮瓣存活情况、并发症发生情况,后期皮瓣修薄情况。随访时,评估中下面部外形与功能改善程度,观察皮瓣外观与质地、供区瘢痕形成情况。Ⅲ期术后12个月,测量16例伴小口畸形患者张口度,采用视觉模拟评分法评估所有患者分别对面部外形及功能改善的满意度。结果 20例患者均顺利完成皮瓣扩张。Ⅱ期术后早期3例患者皮瓣出现静脉回流障碍伴轻度淤血,1周后自行消退；其余患者皮瓣存活良好。5例患者因皮瓣稍厚于Ⅲ期术后3个月行修薄术。Ⅲ期术后随访12~24个月显示,所有患者中下面部外形显著改善,口腔开闭、咀嚼及语言功能均明显改善,皮瓣色泽、质地与受区周围皮肤组织相近,供区遗留线状瘢痕且位于发际线处。Ⅲ期术后12个月,16例伴小口畸形患者张口度增至3.5~4.0 cm；对面部外形改善的满意度评分为8~10分者18例、6~7分者2例,对面部功能改善的满意度评分为9~10分者19例、7~8分者1例。结论扩张颞浅动脉双蒂皮瓣血供可靠、可切取面积大、可转移距离远,应用该皮瓣整复中下面部烧伤后瘢痕挛缩畸形,对供区造成的损伤小、隐蔽性好,能有效改善面部外观与功能,值得临床推广。
- 烧伤 /
- 面部 /
- 瘢痕 /
- 挛缩 /
- 扩张术 /
- 外科皮瓣 /
- 颞浅动脉
Abstract: Objective To explore the clinical effects of using expanded superficial temporal artery double-pedicled flaps in reconstructing scar contracture deformities after burns in the mid and lower face. Methods This study was a retrospective investigation of case series. From January 2020 to January 2025, 20 male patients with scar contracture deformities after burns in the mid and lower face who met the inclusion criteria were admitted to the First People's Hospital of Zhengzhou, aged 15 to 56 years, with a disease course of 1 to 10 years. Among them, 16 patients had scar contracture of the upper and lower lips with small mouth malformation and lip eversion, with a mouth opening degree of 2.0 to 2.5 cm. The expanded superficial temporal artery double-pedicled flap was used to reconstruct the scar contracture deformity. The surgery was divided into three stages. In stage Ⅰ, a cylindrical skin soft tissue expander (hereinafter referred to as expander) with a rated capacity of 500 to 900 mL was placed on the top of the head. If necessary, another expander with a rated capacity of 100 to 200 mL was placed on one or both sides of the temporal region. After surgery, regular water injection was performed for expansion to achieve a final water injection volume of 2 to 3 times the rated capacity of the expander. Five to 6 months after stage Ⅰ surgery, stage Ⅱ surgery was performed. An expanded flap (with an area of 35 cm×11 cm to 54 cm×19 cm) pedicled with bilateral superficial temporal artery top or frontal branches was used to repair the wound formed after scar removal and contracture release. For scar contractures that simultaneously affected both upper and lower lips, a transverse incision of about 6 cm in length was made at the position of the flap corresponding to the normal oral fissure, forming a new oral fissure and restoring the normal position of the mouth corner. The width of the flap used as the upper lip was adjusted to 2.5 to 3.0 cm. The donor site wound was directly sutured, and the incomplete closure was temporarily covered by scar skin patches. Three to 4 weeks after stage Ⅱ surgery, stage Ⅲ surgery was performed, including flap pedicle division and pedicle repair and reset, etc. The expansion of the flap, the survival of the flap and the occurrence of complications after stage Ⅱ surgery, and the thinning of the flap in the later period were recorded. During follow-up, the degree of improvement in the appearance and function of the mid and lower face was evaluated, the appearance and texture of the flap, and the formation of scars in the donor area were observed. Twelve months after stage Ⅲ surgery, the mouth opening degree of 16 patients with small mouth malformation was measured, and the visual analogue scale was used to evaluate the satisfaction of all patients with the improvement of appearance and function of face. Results All 20 patients successfully completed flap expansion. In the early period post stage Ⅱ surgery, three patients experienced venous reflux obstruction and mild congestion in the flaps, which resolved spontaneously after one week; the flaps of the remaining patients survived well. Five patients underwent thinning surgery three months after stage Ⅲ surgery due to slightly thick flaps. Follow up for 12 to 24 months after stage Ⅲ surgery showed significant improvement in the appearance of the mid and lower face in all patients, as well as significant improvement in oral opening and closing, chewing, and language function; the color and texture of the flaps were similar to those of the surrounding skin tissue in the recipient area, and linear scars were left in the donor area located at the hairline. Twelve months after stage Ⅲ surgery, the mouth opening degree of 16 patients with small mouth malformation increased to 3.5 to 4.0 cm; the satisfaction scores for facial appearance improvement were 8-10 in 18 cases and 6-7 in 2 cases, while the satisfaction scores for facial function improvement were 9-10 in 19 cases and 7-8 in 1 case. Conclusions The expanded superficial temporal artery double-pedicled flap has reliable blood supply, a large cutting area, and a long transfer distance. The application of this flap in the reconstruction of scar contracture deformities after burns in the mid and lower face causes minimal damage to the donor area, with good concealment. It can effectively improve facial appearance and function and is worthy of clinical promotion.
- Burns /
- Face /
- Cicatrix /
- Contracture /
- Dilatation /
- Surgical flaps /
- Superficial temporal artery
夏成德、薛继东、狄海萍、王迎秋：手术设计与操作、论文撰写；邢培朋、郭海娜、赵孝开、谢江帆、韩大伟：患者管理、手术操作

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图 1 扩张颞浅动脉双蒂皮瓣整复例1患者中下面部火焰烧伤后瘢痕挛缩畸形的效果。1A.入院时,口周、面颊及颏颈部瘢痕,张口受限,下唇轻度外翻；1B.Ⅰ期注水扩张6个月后情况；1C.Ⅱ期术中切取皮瓣情况；1D.Ⅱ期术中瘢痕切除及挛缩松解后形成的创面；1E.Ⅱ期转移皮瓣修复创面后即刻；1F.Ⅱ期皮瓣转移术后4周断蒂前；1G.Ⅲ期术后12个月面部正面观,下唇外翻纠正,张口度改善；1H.Ⅲ期术后12个月面部右侧面观,供区无明显瘢痕

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图 2 扩张颞浅动脉双蒂皮瓣整复例2患者中下面部火焰烧伤后瘢痕挛缩的效果。2A、2B.分别为入院时面部正、右侧面观,全颜面及颈部瘢痕增生挛缩畸形,伴眉毛缺失、下眼睑外翻、张口受限、下唇外翻、颏颈角消失；2C.Ⅰ期注水扩张6个月后情况；2D.Ⅱ期术中切取扩张皮瓣情况；2E.Ⅱ期行面颈部瘢痕切除+挛缩松解+皮瓣转移术后即刻,皮瓣血运良好；2F.Ⅱ期皮瓣转移术后25 d断蒂前；2G、2H.分别为Ⅲ期术后12个月面部仰位、右侧面观,颏颈角清晰,种植眉毛及面部形态轮廓自然

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