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Volume 39 Issue 3
Mar.  2023
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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

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  • 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.

     

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    Created with Highcharts 5.0.7Chart context menuAccess Area Distribution其他: 27.5 %其他: 27.5 %其他: 0.1 %其他: 0.1 %Grogol: 0.2 %Grogol: 0.2 %三门峡: 0.2 %三门峡: 0.2 %上海: 0.3 %上海: 0.3 %东营: 0.0 %东营: 0.0 %丽水: 1.3 %丽水: 1.3 %乌鲁木齐: 0.0 %乌鲁木齐: 0.0 %乐山: 0.5 %乐山: 0.5 %六安: 0.0 %六安: 0.0 %内江: 0.0 %内江: 0.0 %包头: 0.1 %包头: 0.1 %北京: 0.5 %北京: 0.5 %南京: 0.3 %南京: 0.3 %南平: 0.6 %南平: 0.6 %南通: 0.4 %南通: 0.4 %厦门: 0.3 %厦门: 0.3 %台州: 1.4 %台州: 1.4 %合肥: 0.3 %合肥: 0.3 %咸阳: 0.0 %咸阳: 0.0 %哈尔滨: 0.2 %哈尔滨: 0.2 %哥伦布: 0.1 %哥伦布: 0.1 %唐山: 0.7 %唐山: 0.7 %嘉兴: 1.1 %嘉兴: 1.1 %大连: 1.9 %大连: 1.9 %天津: 0.4 %天津: 0.4 %太原: 0.2 %太原: 0.2 %宁德: 0.4 %宁德: 0.4 %宁波: 0.8 %宁波: 0.8 %安康: 0.7 %安康: 0.7 %宜昌: 0.0 %宜昌: 0.0 %宜春: 0.4 %宜春: 0.4 %宿迁: 1.2 %宿迁: 1.2 %常德: 0.5 %常德: 0.5 %广元: 0.1 %广元: 0.1 %广安: 0.1 %广安: 0.1 %广州: 1.6 %广州: 1.6 %廊坊: 0.1 %廊坊: 0.1 %延安: 1.5 %延安: 1.5 %张家口: 0.4 %张家口: 0.4 %徐州: 1.2 %徐州: 1.2 %德州: 0.2 %德州: 0.2 %德阳: 0.1 %德阳: 0.1 %成都: 0.0 %成都: 0.0 %抚州: 1.7 %抚州: 1.7 %抚顺: 0.6 %抚顺: 0.6 %无锡: 0.8 %无锡: 0.8 %日照: 0.5 %日照: 0.5 %昆明: 0.4 %昆明: 0.4 %朝阳: 0.1 %朝阳: 0.1 %来宾: 0.1 %来宾: 0.1 %杭州: 1.2 %杭州: 1.2 %枣庄: 0.1 %枣庄: 0.1 %株洲: 0.0 %株洲: 0.0 %梧州: 0.2 %梧州: 0.2 %榆林: 0.4 %榆林: 0.4 %武汉: 0.2 %武汉: 0.2 %汕头: 0.9 %汕头: 0.9 %池州: 0.7 %池州: 0.7 %沈阳: 0.6 %沈阳: 0.6 %泉州: 0.1 %泉州: 0.1 %泰州: 0.6 %泰州: 0.6 %泸州: 0.5 %泸州: 0.5 %洛阳: 0.0 %洛阳: 0.0 %济南: 0.8 %济南: 0.8 %济宁: 0.1 %济宁: 0.1 %海得拉巴: 0.1 %海得拉巴: 0.1 %淮北: 0.6 %淮北: 0.6 %淮南: 0.0 %淮南: 0.0 %淮安: 0.0 %淮安: 0.0 %深圳: 0.2 %深圳: 0.2 %温州: 0.4 %温州: 0.4 %渭南: 0.7 %渭南: 0.7 %湖州: 0.7 %湖州: 0.7 %湘潭: 0.0 %湘潭: 0.0 %湘西: 0.7 %湘西: 0.7 %漯河: 0.1 %漯河: 0.1 %漳州: 1.1 %漳州: 1.1 %潍坊: 0.0 %潍坊: 0.0 %濮阳: 0.0 %濮阳: 0.0 %烟台: 0.3 %烟台: 0.3 %盐城: 0.5 %盐城: 0.5 %盘锦: 0.3 %盘锦: 0.3 %石家庄: 1.0 %石家庄: 1.0 %福州: 0.1 %福州: 0.1 %秦皇岛: 0.5 %秦皇岛: 0.5 %绍兴: 0.9 %绍兴: 0.9 %绵阳: 0.2 %绵阳: 0.2 %自贡: 0.3 %自贡: 0.3 %舟山: 0.3 %舟山: 0.3 %芒廷维尤: 8.3 %芒廷维尤: 8.3 %芜湖: 0.7 %芜湖: 0.7 %芝加哥: 0.1 %芝加哥: 0.1 %苏州: 0.4 %苏州: 0.4 %荆门: 1.4 %荆门: 1.4 %莆田: 0.1 %莆田: 0.1 %营口: 0.8 %营口: 0.8 %葫芦岛: 0.3 %葫芦岛: 0.3 %蚌埠: 0.1 %蚌埠: 0.1 %衡水: 0.0 %衡水: 0.0 %衢州: 1.1 %衢州: 1.1 %襄阳: 1.0 %襄阳: 1.0 %西宁: 0.7 %西宁: 0.7 %西安: 2.9 %西安: 2.9 %许昌: 0.1 %许昌: 0.1 %贵阳: 0.1 %贵阳: 0.1 %辽阳: 1.5 %辽阳: 1.5 %运城: 0.1 %运城: 0.1 %连云港: 1.2 %连云港: 1.2 %邵阳: 0.4 %邵阳: 0.4 %郑州: 0.0 %郑州: 0.0 %郴州: 0.9 %郴州: 0.9 %重庆: 2.1 %重庆: 2.1 %金华: 1.4 %金华: 1.4 %铁岭: 0.7 %铁岭: 0.7 %铜陵: 1.0 %铜陵: 1.0 %长沙: 0.2 %长沙: 0.2 %阜新: 0.1 %阜新: 0.1 %雅安: 0.1 %雅安: 0.1 %青岛: 0.2 %青岛: 0.2 %鞍山: 0.8 %鞍山: 0.8 %马鞍山: 0.0 %马鞍山: 0.0 %鹰潭: 1.0 %鹰潭: 1.0 %黄冈: 0.0 %黄冈: 0.0 %黄山: 0.5 %黄山: 0.5 %黄石: 0.8 %黄石: 0.8 %其他其他Grogol三门峡上海东营丽水乌鲁木齐乐山六安内江包头北京南京南平南通厦门台州合肥咸阳哈尔滨哥伦布唐山嘉兴大连天津太原宁德宁波安康宜昌宜春宿迁常德广元广安广州廊坊延安张家口徐州德州德阳成都抚州抚顺无锡日照昆明朝阳来宾杭州枣庄株洲梧州榆林武汉汕头池州沈阳泉州泰州泸州洛阳济南济宁海得拉巴淮北淮南淮安深圳温州渭南湖州湘潭湘西漯河漳州潍坊濮阳烟台盐城盘锦石家庄福州秦皇岛绍兴绵阳自贡舟山芒廷维尤芜湖芝加哥苏州荆门莆田营口葫芦岛蚌埠衡水衢州襄阳西宁西安许昌贵阳辽阳运城连云港邵阳郑州郴州重庆金华铁岭铜陵长沙阜新雅安青岛鞍山马鞍山鹰潭黄冈黄山黄石

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