Rashid Mamoon, Zia-Ul-Islam Muhammad, Sarwar Saad-Ur-Rahman, Bhatti Ahsan Manzoor
Department of Plastic Surgery, Combined Military Hospital, Rawalpindi, Pakistan.
J Plast Reconstr Aesthet Surg. 2006;59(10):1094-101. doi: 10.1016/j.bjps.2005.12.058. Epub 2006 Jun 30.
Soft tissue defects in the cervico-facial region can result from trauma, tumour excision or post-burn scarring. All rungs of the reconstructive ladder offer possible reconstructive options for these defects. The supraclavicular artery based flap is an extremely reliable local flap for this purpose. It offers thin and pliable skin with good colour match and minimal donor site morbidity. An additional advantage, in our experience, is that this skin can stretch postoperatively to allow further improved neck contour and mobility.
Between June 2000 and January 2004, 27 patients underwent reconstruction of neck defects after release of post-burn contractures with the supraclavicular artery based skin flap at our hospital. After discharge the first follow-up visit was on the 10th postoperative day. The patients were advised to wear a custom made Watusi splint for 3 to 4 months. The patients were subsequently followed up at 3 months, 6 months and 1 year. The dimensions of the flap were measured and the patients photographed at the time of discharge and at subsequent visits.
All the flaps survived completely. The average operating time for contracture release and flap coverage was 2 h. The hospital stay ranged from 5 to 8 days. Follow-up ranged from 1 to 4 years with an average of 22 months. Complications included epidermolysis (n=2) and delay in donor site healing (n=2). Almost all patients had some widening of the donor site scar. In our experience the width of the flap increased in the postoperative period. At the time of surgery, the width of the flap ranged between 9 and 12 cm. At the 3-month follow-up there was an average increase in width of 24.2%. At 6 months, the average increase in width was 42.8% of the original flap width. At 1 year the average flap expansion was 63% of the original. The length of the flap ranged from 18 to 24 cm and generally remained unaltered during follow-up.
颈面部软组织缺损可由创伤、肿瘤切除或烧伤后瘢痕形成引起。重建阶梯的所有层级都为这些缺损提供了可能的重建选择。基于锁骨下动脉的皮瓣是用于此目的的极其可靠的局部皮瓣。它提供薄且柔韧的皮肤，颜色匹配良好，供区并发症最少。根据我们的经验，另一个优点是这种皮肤术后可伸展，以进一步改善颈部轮廓和活动度。
2000年6月至2004年1月，我院27例患者在烧伤后挛缩松解后采用基于锁骨下动脉的皮瓣重建颈部缺损。出院后首次随访在术后第10天。建议患者佩戴定制的瓦图西夹板3至4个月。随后在3个月、6个月和1年进行随访。在出院时及后续随访时测量皮瓣尺寸并为患者拍照。
所有皮瓣均完全存活。挛缩松解和皮瓣覆盖的平均手术时间为2小时。住院时间为5至8天。随访时间为1至4年，平均22个月。并发症包括表皮松解（n = 2）和供区愈合延迟（n = 2）。几乎所有患者的供区瘢痕都有一定程度的增宽。根据我们的经验，皮瓣宽度在术后会增加。手术时，皮瓣宽度在9至12厘米之间。在3个月随访时，宽度平均增加24.2%。在6个月时，宽度平均增加为原始皮瓣宽度的42.8%。在1年时，皮瓣平均扩张为原始宽度的63%。皮瓣长度在18至24厘米之间，随访期间一般保持不变。
