Luo Xu-so, Wang Xi, Yang Qun, Liu Fei, Wang Shou-bao, Zhou Xian-yu, Qian Yun-liang, Yang Jun
Department of Plastic Surgery, Shanghai Jiaotong University, Shanghai, China.
Zhonghua Yi Xue Za Zhi. 2013 Apr 9;93(14):1050-4.
To explore serial reconstruction strategy for severe cervical cicatrix deformity.
A total of 24 cases, III or IV degree cervical contracture deformity, were treated in Shanghai Ninth People's Hospital from January 2006 to December 2011. There were 18 males and 6 females with an average age of 35.4 years. The etiologies included burns, chemical injuries and scalding. Three evaluation indices of mental cervical angle (MCA) including soft tissue MCA, osseous MCA and dynamic MCA were measured before treatment and during follow-ups. The first-stage treatment was comprised of cervical cicatrix resection, contracture release, lift of dual direction platysma flap, reconstruction of MCA and skin grafting. At Months 3-6, second-stage treatment was performed, including lower mandible scar resection, correction of lower lip eversion, lower mandible region reconstruction with free (para-) scapular skin flap. After two-stage treatment, the patients underwent periodical re-evaluations for gross appearance, function and measurement of MCA.
Twenty-two patients completing two-stage reconstruction were followed up. Notable improvement of cervical mobilization and contour were achieved. Soft tissue MCA decreased from 130° ± 34° to 110° ± 24°, osseous MCA increased from 71° ± 23° to 95° ± 19° and dynamic MCA increased from 25° ± 18° to 80° ± 26°.
The serial treatment strategy is effective. In comparisons with reconstruction with skin graft only or skin flap only, the strategy possesses many advantages.
探讨重度颈部瘢痕畸形的系列重建策略。
2006年1月至2011年12月，上海交通大学医学院附属第九人民医院共收治24例Ⅲ或Ⅳ度颈部挛缩畸形患者，其中男18例，女6例，平均年龄35.4岁。病因包括烧伤、化学伤和烫伤。于治疗前及随访期间测量包括软组织颈角（MCA）、骨性MCA和动态MCA在内的三项颈角评估指标。一期治疗包括颈部瘢痕切除、挛缩松解、双向颈阔肌肌皮瓣提升、MCA重建及植皮。在3 - 6个月时进行二期治疗，包括下颌下瘢痕切除、下唇外翻矫正、游离（副）肩胛皮瓣修复下颌下区。两期治疗后，对患者的外观、功能及MCA测量进行定期复查。
对22例完成两期重建的患者进行随访，颈部活动度和外形均有明显改善。软组织MCA从130°±34°降至110°±24°，骨性MCA从71°±23°增至95°±19°，动态MCA从25°±18°增至80°±26°。
该系列治疗策略有效。与单纯植皮或单纯皮瓣重建相比，该策略具有诸多优势。
