Li Haizhou, Zhou Yiwen, Du Zijing, Gu Bin, Liu Kai, Xie Feng, Xie Yun, Herrler Tanja, Li Qingfeng, Zan Tao
Department of Plastic and Reconstructive Surgery, Ninth People's Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China.
Hand, Plastic, and Aesthetic Surgery, Department of General, Trauma, Hand, and Plastic Surgery, University of Munich, Munich, Germany.
J Plast Reconstr Aesthet Surg. 2015 Aug;68(8):1064-71. doi: 10.1016/j.bjps.2015.04.002. Epub 2015 Apr 20.
It is still highly challenging to restore the esthetic neck contour for postburn deformities. In many patients with burns, the back skin remains intact, which is a useful donor site for extensive contracture release. As the main technique, the refinement of the pre-expanded superficial cervical artery (SCA) flaps may improve its application in diverse neck contractures.
This study reviewed the cases of three types of neck contractures that were reconstructed with pre-expanded SCA flaps: (1) for unilateral neck contractures, the flaps were harvested as pedicled perforator flaps including a small amount of muscle; (2) for lateral and anterior neck contractures, vascular augmentation with circumflex scapular vessels was used to increase the flap size; (3) for contractures of the entire neck, maximal flap release with pedicle dissection toward the origin of the superficial cervical vessels allowed for reaching contralateral defects.
From March 2010 to September 2012, pre-expanded SCA flaps were recommended in 15 patients with severe neck contracture. Tip necrosis occurred in one patient. The donor sites were closed primarily in all cases. One patient had donor-site wound dehiscence that healed within 2 weeks by conservative management. All patients had restored neck extension to a near-normal position without the sense of restricted neck flexion or rotation.
Pre-expanded SCA flaps are practical and flexible for the reconstruction of diverse scar contractures ranging from unilateral to total neck lesions. Considering the reconstructive efficiency and the reduced donor-site morbidity, this flap may be an ideal option for the reconstruction of severe neck scar contractures.
烧伤后畸形患者颈部美学轮廓的修复仍然极具挑战性。许多烧伤患者的背部皮肤保持完好，这是用于广泛挛缩松解的理想供区。作为主要技术，预扩张颈浅动脉（SCA）皮瓣的改良可提高其在各种颈部挛缩中的应用效果。
本研究回顾了采用预扩张SCA皮瓣重建三种类型颈部挛缩的病例：（1）对于单侧颈部挛缩，皮瓣作为带蒂穿支皮瓣切取，包含少量肌肉；（2）对于颈部外侧和前部挛缩，采用旋肩胛血管进行血管增粗以增加皮瓣面积；（3）对于全颈部挛缩，通过向颈浅血管起始部进行蒂部解剖以最大限度地松解皮瓣，从而修复对侧缺损。
2010年3月至2012年9月，15例严重颈部挛缩患者采用了预扩张SCA皮瓣。1例患者出现皮瓣尖端坏死。所有病例的供区均直接缝合。1例患者供区伤口裂开，经保守治疗2周内愈合。所有患者颈部伸展功能均恢复至接近正常位置，无颈部屈曲或旋转受限感。
预扩张SCA皮瓣对于从单侧到全颈部病变的各种瘢痕挛缩的重建具有实用性和灵活性。考虑到重建效率和供区并发症的减少，该皮瓣可能是严重颈部瘢痕挛缩重建的理想选择。
