Rose E H
Mount Sinai Medical Center, New York, N.Y., USA.
Plast Reconstr Surg. 1995 Dec;96(7):1573-85; discussion 1586-7.
Although highly specialized burn centers have significantly reduced mortality rates following extensive total body surface area burns, survivors are often left with grotesque facial disfigurement. The strategy of modern facial restoration emphasizes enhancement of aesthetic appearance as significantly as mitigation of functional impairment. Criteria for success are (1) an undistracted "normal" look at conversational distance, (2) facial balance and symmetry, (3) distinct aesthetic units fused by inconspicuous scars, (4) "doughy" skin texture appropriate for corrective makeup, and (5) dynamic facial expression. Since 1985, the author has successfully restored 17 severely disfigured burned faces by replacement of entire aesthetic units with microvascular "prepatterned" composite flaps blended into the facial canvas by cosmetic camouflage techniques. The series includes hemiface (2), neck/jaw (5), chin/lower lip (3), cheek/malar (5), peri-orbital (2), nose (3), upper lip (4), and ear reconstructions (4). Flaps represented are free preauricular (1), radial forearm (6), ulnar forearm (1), free scapular (6), ilio-osteocutaneous (2), temporoparietal (8), vascularized forehead island (3), supraclavicular (1), and SMAS (1). Important to outcome is extensive initial intraoperative "sculpting" to simulate normal planes and contours. Seams are placed at junctions of facial components. Three-dimensional imaging is used to assess architectural asymmetries, and bone grafts are aided by computer-generated acrylic models. Adjunctive procedures include tensor fasciae latae slings, intraoperative tissue expansion, suction-assisted lipectomy, and scar management. After restoration of facial form and texture, flesh color make-up and/or tattooing of beard, lips, scars, eyebrows, etc., aid to hide scars and pigment the skin to harmonize with the rest of the face. In all cases, facial integrity has been aesthetically restored and, in most instances, with makeup, is near normal in social settings at conversational distances. Facial animation is retained and color matches are excellent. One flap was lost early in the series.
尽管高度专业化的烧伤中心已显著降低了大面积全身烧伤后的死亡率，但幸存者往往会留下面目全非的面部畸形。现代面部修复策略强调在减轻功能障碍的同时，尽可能地改善美学外观。成功的标准包括：（1）在交谈距离时呈现出不引人注目的“正常”外观；（2）面部平衡与对称；（3）由不明显的疤痕融合的清晰美学单元；（4）适合矫正化妆的“柔软”皮肤质地；（5）动态面部表情。自1985年以来，作者通过用微血管“预构”复合组织瓣替换整个美学单元，并采用美容伪装技术将其融入面部，成功修复了17例严重毁容的烧伤面部。该系列包括半侧面部（2例）、颈部/下颌（5例）、下巴/下唇（3例）、脸颊/颧骨（5例）、眶周（2例）、鼻子（3例）、上唇（4例）和耳部重建（4例）。所采用的组织瓣包括游离耳前组织瓣（1例）、桡侧前臂组织瓣（6例）、尺侧前臂组织瓣（1例）、游离肩胛组织瓣（6例）、髂骨骨皮瓣（2例）、颞顶组织瓣（8例）、带血管蒂前额岛状瓣（3例）、锁骨上组织瓣（1例）和SMAS瓣（1例）。手术结果的关键在于术中进行广泛的初始“塑形”，以模拟正常的平面和轮廓。缝线置于面部各部分的交界处。利用三维成像评估结构不对称性，并借助计算机生成的丙烯酸模型辅助植骨。辅助手术包括阔筋膜张肌吊带术、术中组织扩张术、吸脂辅助脂肪切除术和疤痕处理。在恢复面部形态和质地后，通过肉色化妆和/或对胡须、嘴唇、疤痕、眉毛等进行纹身，有助于隐藏疤痕并对面部皮肤进行色素处理，使其与面部其他部位相协调。在所有病例中，面部完整性均已在美学上得到恢复，并且在大多数情况下，经过化妆后，在交谈距离的社交场合中接近正常。面部的活动能力得以保留，肤色匹配效果极佳。该系列中有1例组织瓣早期丢失。
