Zhang Yi Xin, Wang Danru, Follmar Keith E, Yang Jun, Ong Yee Siang, Messmer Caroline, Coan Brian, Erdmann Detlev, Qian Yunliang, Levin L Scott
Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Ann Plast Surg. 2010 Dec;65(6):528-34. doi: 10.1097/SAP.0b013e3181cc29e7.
The authors describe an algorithm for reconstruction of both the soft tissue and skeletal components of severe postburn neck deformities. The critical functional and aesthetic importance of the cervicomental angle is emphasized. The neck is subdivided into 3 anatomic subunits: (1) lower lip/chin subunit, (2) submental subunit, and (3) anterior neck subunit. After release of contractures, platysmaplasty is performed to prevent recurrence and to deepen the cervicomental angle. In cases where chin retrusion is present, sliding genioplasty is performed. The 3 subunits are resurfaced individually by skin grafts and free flaps. The combined scapular and parascapular bilobed free flap is an ideal flap for cases involving 2 subunits. Fifty patients with severe postburns neck contractures were treated. After excision and release of scar, 47 (94%) patients underwent platysmaplasty, and 12 (24%) patients underwent sliding genioplasty. Defects were covered with skin grafts alone in 20 (40%) patients, with free flaps only in 22 (44%) patients, and with a combination of skin grafts and free flaps in 8 (16%) patients.
作者描述了一种用于重建严重烧伤后颈部畸形的软组织和骨骼成分的算法。强调了颈颌角在功能和美学方面的关键重要性。颈部被细分为3个解剖亚单位：(1)下唇/下巴亚单位，(2)颏下亚单位，(3)前颈部亚单位。在挛缩松解后，进行颈阔肌成形术以防止复发并加深颈颌角。在存在下巴后缩的情况下，进行滑动颏成形术。这3个亚单位分别通过植皮和游离皮瓣进行修复。联合肩胛和肩胛旁双叶游离皮瓣是涉及2个亚单位病例的理想皮瓣。对50例严重烧伤后颈部挛缩患者进行了治疗。在切除和松解瘢痕后，47例(94%)患者接受了颈阔肌成形术，12例(24%)患者接受了滑动颏成形术。20例(40%)患者的缺损仅用植皮覆盖，22例(44%)患者仅用游离皮瓣覆盖，8例(16%)患者用植皮和游离皮瓣联合覆盖。
