2nd Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
J Craniofac Surg. 2023 Jun 1;34(4):1325-1328. doi: 10.1097/SCS.0000000000009215. Epub 2023 Mar 1.
Extensive facial burn scars are a tragedy for patients and often pose a great challenge to surgeons because of the high esthetic and functional demands. For patients with healthy skin in the neck region, a cervical flap is highly recommended for facial resurfacing; however, the skin on the midline of the neck often needs more expansion than that on either side, especially for the treatment of large facial defects. The sufficient longitudinal soft tissue in the anterior neck ensures a normal neck shape as well as a normal range of cervical extension, rotation, and lateral flexion. To overcome this, we developed an expanded cervical flap with an overlapping tissue expansion technique to gain more length centrally.
First, 2 tissue expanders were embedded in the anterior neck region overlapping each other at the midline of the neck. After adequate inflation of the expander, the expanded flap was dissected and rotated to repair defects in the middle and lower face. The anchor position of the flap was placed on the horizontal line of the thyroid cartilage to restore the cervicomental angle.
Sixteen patients were treated with this method in this single-center study. All defects affected the middle and lower face, with an area ranging from 135 to 185 cm 2 , and were caused by a massive facial burn. Among them, 12 patients suffered ectropion of the lower lip, 3 suffered limited mouth opening due to scar contraction, and one patient had a cervicomental adhesion. The area of the expanded flap was approximately 163 to 266 cm 2 . The average period of expansion was 89.5 days. Patients were followed up after the operation, with the follow-up period ranging from 6 to 12 months. In all cases, good defect coverage was achieved, with primary closure of the donor sites and a good postoperative cervical configuration.
We conclude that the expanded cervical flap with the overlapping tissue expansion technique proved to be a reliable method for facial skin reconstruction with functional and aesthetic improvement.
广泛的面部烧伤疤痕对患者来说是一场悲剧，由于对美观和功能的高要求，往往对外科医生构成极大挑战。对于颈部有健康皮肤的患者，建议使用颈侧皮瓣进行面部修复；然而，颈部中线的皮肤通常需要比两侧更多的扩张，尤其是对于大面积面部缺陷的治疗。颈部前方有足够的纵向软组织，可以确保正常的颈部形状以及正常的颈部伸展、旋转和侧屈范围。为了克服这个问题，我们开发了一种带有重叠组织扩张技术的扩张颈瓣，以在中央获得更长的长度。
首先，在颈部中线将 2 个组织扩张器重叠埋置于颈部前侧。在扩张器充分充气后，将扩张皮瓣切开并旋转以修复中下面部的缺陷。皮瓣的锚定点置于甲状软骨的水平线以恢复颈颏角。
在这项单中心研究中，16 例患者采用这种方法治疗。所有缺陷均影响中下面部，面积从 135 到 185cm²不等，均由大面积面部烧伤引起。其中 12 例患者出现下唇外翻，3 例因瘢痕挛缩导致张口受限，1 例患者出现颈颏粘连。扩张皮瓣的面积约为 163 到 266cm²。平均扩张时间为 89.5 天。术后对患者进行随访，随访时间为 6 至 12 个月。所有病例均获得良好的缺损覆盖，供区可直接缝合，术后颈部形态良好。
我们认为，带有重叠组织扩张技术的扩张颈瓣是一种可靠的方法，可用于改善功能和美观的面部皮肤重建。
