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Title: [Clinical effects of expanded super-thin perforator flaps in the shoulder, neck, and chest in reconstruction of extensive burn scars in the face].
Author: Yang SF, Wang CM, Liu LC, Xu KY, Xiao SP, Mei J, Yan L.
Journal: Zhonghua Shao Shang Za Zhi; 2019 Sep 20; 35(9):661-667. PubMed ID: 31594184.
Abstract:
Objective: To explore the clinical effects and key techniques of expanded super-thin perforator flaps in the shoulder, neck, and chest in reconstruction of extensive burn scars in the face. Methods: From January 2008 to November 2018, 22 patients with extensive burn scars in the face were admitted to the Department of Plastic Surgery of Dongguan Kanghua Hospital and the Department of Plastic Surgery of Dermatology Hospital of Southern Medical University, with 3 males and 19 females, aged from 4 to 48 years. There were 16 cases of type Ⅱ and 6 cases of type Ⅲ in facial scars. Before the first stage of expansion surgery, Doppler blood flow survey meter or multi-slice CT was used to locate the perforator vessels. One to four expanders with rated capacity ranged from 100 to 600 mL were placed in the patients. We gave 20% to 30% of the rated capacity of expander intro-operation and common injection with 10% to 15% of the rated capacity of expander per week post-operation until the volume reached 1.5 to 2.5 times of the rated capacity of expander during the past 3 to 4 months. At the second stage of surgery, the perforators were located again before surgery with the same method. The size of defects after the excision of facial scars ranged from 6 cm×4 cm to 18 cm×16 cm. With perforators used as nutrient vessels, narrow pedicle flaps or random flaps ranging from 6 cm×6 cm to 22 cm×18 cm were elevated as rotating or advancing to reconstruct the defects. The donor sites were sutured directly. Some of the flaps needed stage Ⅲ operation for cutting the pedicle. The survival of flaps, post-operation complications, and follow-up were assessed. Results: All flaps of 22 patients survived. All the donor sites were closed simultaneously. One patient underwent an additional surgery for 5 cm×4 cm necrosis on distal part of flap caused by subcutaneous hematoma. Two patients with epidermis blister on the flaps were healed by themselves after dressing change. Due to rapid expansion, blood capillary proliferation appeared on the central part of the flap in 3 cases, after slowing down the expansion speed properly, which had no impact on flap transfer. No ischemia or venous congestion phenomenon were observed in the other flaps. During follow-up of 5 to 48 months, the flaps of patients showed no significant bloated appearance, with good complexion and texture, and even could reproduce facial fine-grained expressions naturally. Conclusions: For the reconstruction of extensive burn scars in the face, expanded super-thin perforator flaps can not only acquire large and thin flaps with high matching degree surface skin defect, but also reproduce facial fine-grained expressions. It is a simple and safe method which conforms to the facial aesthetic standard. 目的： 探讨应用肩颈胸部扩张超薄穿支皮瓣修复面部大面积烧伤瘢痕的临床效果和关键技术。 方法： 2008年1月—2018年11月，东莞康华医院整形外科及南方医科大学皮肤病医院整形外科收治22例面部大面积烧伤瘢痕患者，其中男3例、女19例，年龄为4～48岁。其中Ⅱ型瘢痕患者16例、Ⅲ型瘢痕患者6例。Ⅰ期扩张术前应用多普勒超声血流探测仪或多排螺旋CT定位穿支血管。本组患者埋置1～4个扩张器，额定容量为100～600 mL，术中即时注水为扩张器额定容量的20%～30%，术后每周1次常规注水扩张，每次注水量为扩张器额定容量的10%～15%。本组患者注水时间为3～4个月，直至容量达到扩张器额定容量的1.5～2.5倍。Ⅱ期术前同法再次定位穿支，本组患者面部瘢痕切除后缺损面积为6 cm×4 cm～18 cm×16 cm，以穿支血管为营养血管，形成窄蒂皮瓣或任意皮瓣，面积为6 cm×6 cm～22 cm×18 cm，以旋转、推进方式转移修复缺损，供区直接缝合。部分患者进行Ⅲ期断蒂手术。评估皮瓣成活情况、术后的并发症情况以及随访情况。 结果： 本组22例患者皮瓣均成活，供区同期闭合。其中1例患者皮瓣因皮下血肿远端坏死5 cm×4 cm，再次手术修复；2例患者皮瓣表皮出现水疱，换药后自行愈合；3例患者皮瓣因扩张过快，皮瓣中部出现毛细血管增生反应，经适当减慢注水速度，未影响后期皮瓣转移；余患者皮瓣无动脉缺血或静脉淤血现象。随访5个月～4年，所有患者的皮瓣外观不显臃肿，肤色质地良好，能再现面部精细表情。 结论： 对于大面积面部烧伤瘢痕的修复，扩张超薄穿支皮瓣法不仅可获得高度匹配且大而薄的皮瓣，而且能够再现面部精细表情，是一种贴合颜面部美学标准的简单、安全的方法。.

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