Li Binbin, Chen Changyong, Li Wenzhi, Sun Zhi
Zhonghua Zheng Xing Wai Ke Za Zhi. 2017 Mar;33(2):102-5.
To investigate the feasibility and therapeutic effect of frontal and scalp expanded skin flap combined with laser hair removal for children congenital facial giant nevi.
From January 2013 to December 2015,6 cases with congenital facial giant nevi were treated with expanded frontal and scalp skin flap combined with laser hair removal in the department of plastic surgery, An Zhen Hospital, Capital Medical University. The process of treatment could be divided into three stages. Stage 1:The expander capacity was determined according to the size of lesion. Expander was implanted under the galea aponeurotica in front and scalp, and expanded regularly postoperatively. Stage 2:The expander was removed and facial giant nevi was excised. The expanded skin flap was designed according to the shape and size of nevi. Stage 3:After the expanded skin flap healed completely, laser hair removal was performed for 4-6 times with 6 weeks of interval time.
300 ml to 350 ml expanders were selected with expanding frequency of 2 times a week. The expansion time lasted for 16 to 20 weeks(average,18.7 weeks).The complications such as leakage, angle and skin flap blood supply obstacle didnt occurr in the process of expansion. The size of frontal and scalp skin flap ranged from 12 cm × 11 cm to 20 cm × 17 cm. Venous drainage disorder happened in one flap and was treated by partial suture removal and acupuncturebleeding treatment. Skin flap necrosis didn't occurred. The defects at donor sites were sutured directly with inconspicious scar. The effect of semiconductor laser hair removal was good without recurrence during oneyear follow-up period. All expanded skin flaps had no obvious contraction with good match of color and texture.
This method provides a new selection of donor site for larger facial defect with reliable effect. The facial giant nevi could be excised completely and repaired in one operation with short operation time. The scar in middle face and secondary deformities can be avoided.
探讨额部及头皮扩张皮瓣联合激光脱毛治疗儿童先天性面部巨痣的可行性及治疗效果。
2013年1月至2015年12月，首都医科大学附属北京安贞医院整形科对6例先天性面部巨痣患儿采用额部及头皮扩张皮瓣联合激光脱毛治疗。治疗过程分为三个阶段。第一阶段：根据病变大小确定扩张器容量。将扩张器植入额部及头皮帽状腱膜下，术后定期注水扩张。第二阶段：取出扩张器，切除面部巨痣。根据痣的形状和大小设计扩张皮瓣。第三阶段：扩张皮瓣完全愈合后，间隔6周进行4～6次激光脱毛。
选用容量为300～350ml的扩张器，每周注水2次，扩张时间为16～20周（平均18.7周）。扩张过程中未出现渗漏、成角及皮瓣血运障碍等并发症。额部及头皮皮瓣面积为12cm×11cm～20cm×17cm。1例皮瓣出现静脉回流障碍，经部分拆线及针刺放血治疗后好转。未发生皮瓣坏死。供区创面直接缝合，瘢痕不明显。半导体激光脱毛效果良好，随访1年无复发。所有扩张皮瓣无明显挛缩，颜色、质地匹配良好。
该方法为较大面部缺损提供了新的供区选择，效果可靠。可一次性完整切除并修复面部巨痣，手术时间短，可避免面中部瘢痕及继发畸形。
