Dai Xinyue, Zhang Zixuan, Zang Mengqing, Zhu Shan, Li Shanshan, Chen Zixiang, Jin Shengyang, Liu Yuanbo
Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Shijingshan, Beijing, P.R. China.
J Craniofac Surg. 2025;36(5):1514-1519. doi: 10.1097/SCS.0000000000011079. Epub 2025 Jan 9.
Cervical burn scar contractures can be repaired using many modalities, including skin grafts, pedicled and free flaps. Although preexpanded cervical flaps can provide a like-with-like reconstruction, a simple advancement transfer of the flaps often fails to achieve ideal outcomes. The authors aimed to introduce a method using the preexpanded cervical flaps transferred in a scarf-wrapping manner to repair neck defects.
The surgery was divided into 2 stages. In the first stage of the surgery, an expander was implanted above the platysma muscle on each side of the neck. After adequate inflation of the expanders, second-stage operations commenced. Following the expander removal, one flap was rotated upward to repair the neck defect, whereas the other flap was rotated downward to repair the neck defect and close the donor site of the first flap. Data on patient demographics, clinical characteristics, and outcomes were also collected.
Between July 2004 and May 2024, 24 patients underwent neck reconstructions using this method. Four patients had grade I cervical contractures, and 20 had grade II. The mean size of the defects was 15.62×5.75 cm (range: 6×6-18×10 cm). The average dimension of the neck flap was 15.02×7.65 cm (range: 9×6-20×10 cm). All the flaps survived with no perfusion-related complications. The average improvement in the cervico-mental angle was 29.25 degrees (range: 10-45 degrees). Postsurgery follow-up ranged from 4 to 155 months (mean: 22 mo). All patients and their families were satisfied with the outcomes.
Preexpanded cervical flaps transferred in a scarf-wrapping manner can be used to reconstruct grade I and II cervical scar contractures and provide a like-with-like reconstruction of the neck.
颈部烧伤瘢痕挛缩可采用多种方式修复，包括皮肤移植、带蒂皮瓣和游离皮瓣。尽管预扩张颈部皮瓣可实现类似组织的重建，但皮瓣单纯推进转移往往无法达到理想效果。作者旨在介绍一种采用围巾包裹方式转移预扩张颈部皮瓣修复颈部缺损的方法。
手术分为两个阶段。在手术的第一阶段，在颈部两侧的颈阔肌上方植入扩张器。扩张器充分扩张后，开始第二阶段手术。取出扩张器后，一块皮瓣向上旋转以修复颈部缺损，而另一块皮瓣向下旋转以修复颈部缺损并封闭第一块皮瓣的供区。还收集了患者的人口统计学数据、临床特征和治疗结果。
2004年7月至2024年5月，24例患者采用该方法进行颈部重建。4例为Ⅰ级颈部挛缩，20例为Ⅱ级。缺损的平均大小为15.62×5.75 cm（范围：6×6 - 18×10 cm）。颈部皮瓣的平均尺寸为15.02×7.65 cm（范围：9×6 - 20×10 cm）。所有皮瓣均存活，无灌注相关并发症。颈颌角平均改善29.25度（范围：10 - 45度）。术后随访时间为4至155个月（平均：22个月）。所有患者及其家属对治疗结果满意。
采用围巾包裹方式转移的预扩张颈部皮瓣可用于重建Ⅰ级和Ⅱ级颈部瘢痕挛缩，并实现颈部类似组织的重建。
