Parrett Brian M, Pomahac Bohdan, Orgill Dennis P, Pribaz Julian J
Boston, Mass. From the Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School.
Plast Reconstr Surg. 2007 Dec;120(7):1871-1878. doi: 10.1097/01.prs.0000287272.28417.14.
The reconstruction of head and neck burns is challenging, traditionally involving skin grafting and local flaps. Free flaps have improved in versatility and variability in recent years, and are now among the techniques used for burn reconstruction.
Thirty-six free flaps for 32 patients with cervicofacial burns were reviewed retrospectively over a 17-year period (1989 to 2005) to determine indications, methods, and outcomes.
The mean patient age was 31 years. Thirteen flaps were transferred to the neck and 23 to the face. The main indication was contractures or hypertrophic scarring followed by exposed bone or cartilage. The majority of flaps were transferred for secondary reconstruction. The free flaps most frequently used were the anterolateral thigh (31 percent), scapular/parascapular (31 percent), and radial forearm (17 percent). Fourteen were prefabricated, one was prelaminated, and 15 were tissue-expanded. A total of 34 flaps (94 percent) were successful. There were no deaths, two donor-site complications, a 17 percent tip necrosis rate, and a 6 percent flap infection rate. The median hospital stay was 6 days after free flap transfer. Patients were followed for at least 1 year, and 64 percent of flaps needed further debulking or sculpting.
Free tissue transfer is a valuable tool in head and neck burn reconstruction. It can be used safely and effectively with minimal morbidity in selected patients.
头颈部烧伤的重建具有挑战性，传统上包括皮肤移植和局部皮瓣。近年来，游离皮瓣在通用性和可变性方面有所改进，现已成为烧伤重建所使用的技术之一。
回顾性分析1989年至2005年17年间32例面颈部烧伤患者所接受的36例游离皮瓣，以确定其适应证、方法和结果。
患者平均年龄为31岁。13例皮瓣转移至颈部，23例转移至面部。主要适应证为挛缩或肥厚性瘢痕形成，其次为骨或软骨外露。大多数皮瓣用于二期重建。最常使用的游离皮瓣是股前外侧皮瓣（31%）、肩胛/肩胛旁皮瓣（31%）和桡侧前臂皮瓣（17%）。14例为预制皮瓣，1例为预分层皮瓣，15例为组织扩张皮瓣。共有34例皮瓣（94%）成功。无死亡病例，有2例供区并发症，皮瓣尖端坏死率为17%，皮瓣感染率为6%。游离皮瓣转移后中位住院时间为6天。对患者进行了至少1年的随访，64%的皮瓣需要进一步减容或塑形。
游离组织移植是头颈部烧伤重建的一种有价值的工具。在选定的患者中，它可以安全有效地使用，且发病率最低。
