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携带浅静脉的游离骨间后动脉穿支皮瓣修复重度口周瘢痕增生挛缩的临床疗效

[Clinical effect of free posterior interosseous artery perforator flap carrying superficial vein for reconstructing severe perioral scar hyperplasia and contracture].

作者信息

Zhang H R, Zhang D L, Yan X H, Zhang X P, Shang X L, Meng Y B

机构信息

Institute of Burns, General Hospital of TISCO (the Sixth Hospital of Shanxi Medical University), Taiyuan 030009, China.

Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China.

出版信息

Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi. 2023 Dec 20;39(12):1175-1179. doi: 10.3760/cma.j.cn501225-20231031-00162.

Abstract

To observe the clinical effect of free posterior interosseous artery perforator flap carrying superficial vein for reconstructing severe perioral scar hyperplasia and contracture. The retrospective observational study method was used. From August 2019 to March 2023, 11 patients with severe perioral scar hyperplasia and contracture after severe facial burns who met the inclusion criteria were admitted to General Hospital of TISCO (the Sixth Hospital of Shanxi Medical University). All patients were male and aged 23 to 56 years, with an average age of 31.3 years. After the perioral scar was removed and released, the wound area was 3.0 cm×2.0 cm to 10.5 cm×2.0 cm. The free posterior interosseous artery perforator flap carrying superficial vein was used to repair the wound, and the flap incision area was 3.5 cm×2.5 cm to 11.0 cm×2.5 cm. Among them, 6 patients required repair of wounds after resecting scar around ipsilateral upper and lower lips, and the lobular treatment of the flap was conducted. The wound in the flap donor area was directly sutured. After surgery, the survival of the flap and the occurrence of vascular crisis were observed. During follow-up after surgery, the appearance, texture, and color of the flap, the appearance of the flap donor area, and improvements of crooked mouth, drooling, limited mouth opening, and lip valgus in patients were observed. All the flaps in patients completely survived after surgery, with no occurrence of vascular crisis. During follow-up of 6 to 36 months after surgery, the flap was not significantly bloated, was soft in texture, and had a similar color to that of the normal facial skin. Only linear scars were left in the flap donor area, and crooked mouth, drooling, limited mouth opening, and lip valgus in patients were significantly improved. The free posterior interosseous artery perforator flap carrying superficial vein can reconstruct severe perioral scar hyperplasia and contracture, with low incidence of postoperative flap vascular crisis, and the lobular treatment of flaps can repair wounds around unilateral upper and lower lips at the same time. After surgery, the appearance and function of the perioral area are significantly improved. The flap is a good choice for repairing small area of severe perioral scar hyperplasia and contracture.

摘要

观察携带浅静脉的骨间后动脉穿支游离皮瓣修复重度口周瘢痕增生挛缩的临床效果。采用回顾性观察研究方法。2019年8月至2023年3月,收治符合纳入标准的11例重度面部烧伤后口周瘢痕增生挛缩患者,均为男性,年龄23~56岁,平均年龄31.3岁。口周瘢痕切除松解后创面面积为3.0 cm×2.0 cm至10.5 cm×2.0 cm。采用携带浅静脉的骨间后动脉穿支游离皮瓣修复创面,皮瓣切取面积为3.5 cm×2.5 cm至11.0 cm×2.5 cm。其中6例患者需切除同侧上下唇周围瘢痕后修复创面,并行皮瓣分叶处理。皮瓣供区创面直接缝合。术后观察皮瓣存活及血管危象发生情况。术后随访观察皮瓣外观、质地、颜色,皮瓣供区外观,以及患者口角歪斜、流涎、张口受限及唇外翻改善情况。患者术后皮瓣全部完全存活,未发生血管危象。术后6~36个月随访,皮瓣无明显臃肿,质地柔软,颜色与面部正常皮肤相近。皮瓣供区仅遗留线状瘢痕,患者口角歪斜、流涎、张口受限及唇外翻明显改善。携带浅静脉的骨间后动脉穿支游离皮瓣可修复重度口周瘢痕增生挛缩,术后皮瓣血管危象发生率低,皮瓣分叶处理可同时修复单侧上下唇周围创面。术后口周外观及功能改善明显。该皮瓣是修复小面积重度口周瘢痕增生挛缩的良好选择。

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