摘要
目的观察颈横动脉颈段皮支皮瓣修复颈部瘢痕挛缩的临床效果。方法笔暂单位1988—2011年收治颈前区烧伤后瘢痕挛缩患者66例.采用颈横动脉颁段皮支皮瓣修复患者颈部瘢痕，包括岛状皮瓣55例（其中9例行预扩张）、非岛状皮瓣ll例（其中l例行预扩张）。术中先切除、松解患行领部瘢痕，在锁骨上、下及前胸区设计颈横动脉颈段皮支皮瓣，其轴心血管为颈横动脉在胸锁乳突肌、肩胛舌骨肌交界处穿出的皮动脉。皮瓣后界达斜方肌前缘，外侧界达三角肌中段，内侧界达胸骨中线，下界达乳头下3．0～4．0cm处。术中先切开皮瓣外、下、内缘，锐性分离达锁骨平面后政为钝性剥离，分离到蒂部后，分离深度以皮瓣旋转后可无张力覆盖创面为度。其中预扩张的皮瓣供Ⅸ直接拉拢缝合．非预扩张皮瓣供区植皮封闭。结果本组患者中64例术后皮瓣成活良好；2例术后皮瓣下血肿致尖端部分坏死，经补允植皮后治愈；供区均愈合。所有皮瓣色泽、质地与周围组织匹配良好；皮瓣感觉功能术后初期恢复为胸部感觉，6个月后完全恢复为颈部感觉。结论颈横动脉颈段皮支皮瓣血供恒定．解剖操作相对简便，皮瓣色泽、质地与颈部相近，是修复颈鄙严重瘢痕挛缩的良好选择。
Objective To observe the therapeutic effect of repairing cervical sear eontraeture using flaps carrying cervical cutaneous branch of the transverse cervical artery. Methods Sixty-six patients with scar contracture after burn in anterior region of neck hosptalized from 1988 to 2011. The sears were excised and repaired with flaps containing the cervical c.utaneous branch oftransw＇rse cervical artery. They included 55 island flaps （ with 9 flaps pre-expanded） and 11 non-island faps （ with 1 flap pre-expanded）. After removing the scar and releasing the contrature, flaps with the cervical cutaneous branch of transverse cervical ariery, were designed and raised in the supraelavieular and infraclavicular regions and the anterior thoracic region. The axial vessel of the flap was the cutaneous artery, which perforated in the crossing area of stemocheidomastoid muscle and omohvoid muscle and originated from the transverse cervical artery. The posterior borderline of the tlap reached the anterior border of the trapezius muscle. Its exterior borderline reached the middle part of deltoid muscle, and its interior borderline ended at the midsternal line. The lower borderline was located 3.0-4.0 cm below the nipple. The incisions at the interior, lower, and exterior borders of the flap were first made. Then afler sharp dissection to the clavicle, blunl dissection was performed to the pedicle to allow the flaps to be able lo cover the wound after rotation without undue tension, The pre-expanded donor sites were sutured directly, while the un-expanded ones were covered with skin graft. Results Out of the 66 flaps, 64 flaps surviw＇d. Two flaps showed partial necrosis at the distal end due to sub-flap hemaloma, and they healed after skin grafting. All the donor sites healed. The color and texture of all flaps matched well with the surrounding skin tissue. The flaps regained sensation pertaining to the chest in the early, stage, and complete sensation pertaining to the neck appeared 6 months after surgery. Conclusions The flap containing cervical eulaneous branch of the transverse cervical artery is a good choice for repairing severe cervical sear contrature for its simple harvest, reliable blood supply, and similar cohor and texture to the skin of cervical region.
出处
《中华烧伤杂志》
CAS
CSCD
北大核心
2012年第4期256-259,共4页
Chinese Journal of Burns
关键词
外科皮瓣
颈
瘢痕
挛缩
Surgical flaps
Neck
Cicatrix
Contracture
