摘要
目的:探讨应用双侧扩张肩胛皮瓣游离移植治疗儿童、青少年大面积颌颈部瘢痕的可行性。方法 :回顾2018年8月-2020年12月间,在上海交通大学医学院附属第九人民医院小儿整形病区接受双侧背部扩张皮瓣治疗大面积颌颈部瘢痕的儿童、青少年患者7例。所有患者瘢痕累及范围包括颈部及下颌、前胸部,颈部瘢痕累及颈前区及一侧或双侧颈外侧区,存在不同程度的颈部活动障碍、下颌骨发育不良。手术分为两期,Ⅰ期在双侧背部设计旋肩胛动脉扩张穿支皮瓣并植入扩张器,并行6~14个月的扩张;Ⅱ期行颌颈部瘢痕切除、松解,扩张皮瓣游离移植修复创面,吻合双侧面动、静脉与旋肩胛动脉及伴行静脉,供区创面直接缝合。结果:7例患者中,出现扩张器植入后切口愈合不良、皮瓣破裂1例,经手术治疗后愈合并完成皮瓣扩张。注水壶堵塞1例,经注水壶外置后完成扩张。皮瓣移植后,1例患者出现皮瓣远端小面积缺血坏死,换药后创面愈合。术后随访6个月~2年,患者颌颈角恢复正常,颈部后伸、前屈、侧曲、旋转明显改善,功能改善满意。2例患者进行皮瓣修薄术及瘢痕条带松解术。结论:旋肩胛动脉位置恒定,支配的背部皮肤面积大,经扩张后的双侧肩胛皮瓣游离移植可修复儿童、青少年颌颈部大面积瘢痕增生挛缩畸形,供区隐蔽、继发损伤小。
PURPOSE: To explore the feasibility of applying bilateral free expanded scapular flaps to treat extensive cervicomandibular scar in children and adolescents. METHODS: This study reviewed 7 children and adolescent patients who received bilateral expanded scapular flaps to treat extensive cervicomandibular scars in the Pediatric Plastic Surgery Ward from August 2018 to December 2020. The scars in all patients involved neck, mandible, and anterior chest. The cer-vical scars involved the anterior neck and one or both sides of the lateral neck, and there were varying degrees of cervical dysfunction and mandibular dysplasia. The operation was completed into two stages. In the first stage, the expanded cir-cumflex scapular artery perforator flaps were designed on both sides of the back and soft tissue expanders were implanted.The expansion process lasted for 6-14 months. In the second stage, the scar tissue was removed and contracture was released,and the expanded flaps were harvested. The cervical wound was repaired with free flap transplantation by anastomosing the facial artery and vein with the circumflex scapular artery and vein. The donor sites were closed directly. RESULTS: In this series of 7 patients, one patient had poorly healed incision after the expander was implanted. One expanded flap ruptured before the second-stage surgery, which was successfully treated by secondary surgery. One patient had expansion problem due to the blockage of the internally placed injection bottle, which was treated by placing the injection bottle externally.One patient developed a small area of ischemic necrosis at the distal end of the flap after transplantation, which was treat-ed conservatively with dressing change. The postoperative follow-up was 6 months to 2 years. The cervico-mandibular an-gle restored to normal range, the cervical extension, flexion, and rotation were significantly improved. Two patients underwent flap thinning and scar releasing. CONCLUSIONS: The route of the circumflex scapular artery is constant. Bilateral expanded scapular flap transplantation can be used to repair extensive cervicomandibular scar in children and adolescent patients.The flap donor site is concealed and secondary damage is minimal.
作者
傅秀军
王琛
梁奕敏
周仁鹏
王丹茹
FU Xiu-jun;WANG Chen;LIANG Yi-min;ZHOU Ren-peng;WANG Dan--nu(Department of Plastic and Reconstrutive Surgery,Shanghai Ninth People's Hospital,Shanghai Jjiao Tong Univrsity School of Medicine.Shanghai 200011,China)
出处
《上海口腔医学》
CAS
北大核心
2021年第3期332-336,共5页
Shanghai Journal of Stomatology
关键词
颌颈部瘢痕
下颌骨发育不良
儿童
青少年
肩胛皮瓣
扩张皮瓣
Extensive cervicomandibular scar
Mandibular dysplasia
Children
Adolescents
Scapular flap
Expanded flap
