Analysis of the effect of four kinds of pre-expanded flaps in the repair of facial and neck subunits
10.3760/cma.j.cn114453-20200507-00268
- VernacularTitle:四类预扩张皮瓣对面颈部亚单位病损的修复效果分析
- Author:
Yinke TANG
1
;
Feifei CHU
;
Xianjie MA
Author Information
1. 空军军医大学第一附属医院（西京医院）整形外科，西安 710032
- Keywords:
Tissue expansion;
Surgical flaps;
Reconstruction;
Facial;
Cicatrix
- From:
Chinese Journal of Plastic Surgery
2020;36(10):1088-1094
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the scheme and strategy of four kinds of pre-expanded skin flaps used for reconstruction of the face and neck subunit lesions.Methods:From January 2014 to June 2019, 493 cases of facial and neck lesions were repaired with four types of pre-expanded flaps in Plastic Surgery Department of Xijing Hospital. There were 207 males and 286 females aged from 5 to 42 years, 406 face and neck scars and 87 pigment lesions. The lesion area ranged from 1 cm×1 cm to 22 cm×18 cm. The face and neck were divided into 8 regions: middle facial region, cheek region, neck region, chin region, frontal region, temporal region, periorbital region and perioral region. According to the regional characteristics of the facial and neck subunits, the expandable skin flaps were selected: type Ⅰ expanded forehead midline flap to repair the lesions in middle facial region; and type II expanded thoracic deltoid flap was used to repair the lesions in the cheek, perioral region and chin neck region below the level of eye; type III expanded neck transverse flap was used to repair the lesions in the neck region and chin region; type IV expanded head flap was used to repair the lesions in the frontal region and temporal region, the excess hair of the transferred skin flap were removed by laser.For large cross-subunit lesions, multiple expanded flaps were used in combination to observe the effect of different types of pre-expanded flaps.Results:There were 493 patients with 572 implanted expanders, 486 patients with effective dilatation successfully completed the repair and reconstruction of the facial subunits. The other 7 patients failed due to dilatation due to dilator infection and exposure. There were 43 forehead expanded flaps type I, 238 thoracic deltoid expanded flaps type II, 61 neck transverse expanded flaps type III, 107 head expanded flaps type IV, 6 I + II combined flaps and 31 II + IV combined flaps. The area of expanded flaps ranged from 1 cm×1 cm to 27 cm×18 cm. Among the single flaps, the thoracic deltoid expanded flap had the largest repair area, about 22 cm×12 cm; the combined flap used the thoracic deltoid and head expanded flap to repair the facial and neck lesions with a maximum of about 27 cm×18 cm. After operation, 8 cases had blood supply disorder at the distal end of the flap, which were healed gradually after pressure dressing and dressing change, without obvious scar hyperplasia. The appearance and function of all expanded flaps were significantly improved. After 6 months to 4 years of follow-up, the color, thickness and texture of the flap were similar to the original site, and the scar was not obvious. However, due to the movement and traction of the flap edge, 42 patients had scar contracture when their head was tilted backward, which disappeared when they were under horizontal vision.Conclusions:For the lesions of the facial and neck subunits, the flexible application and combination of 4 kinds of pre-expanded skin flaps on the face and around can be used, which can provide a large area of thin-layer skin flap. It is not only good in blood supply, but also similar in texture and color to the recipient area. It is a good method to repair the lesions of face and neck.
