Angrigiani C
Plast Reconstr Surg. 1994 Mar;93(3):507-18.
Eighty-six patients with anterior neck burn sequelae underwent scar resection up to the limits of the aesthetic unit of the neck and immediate resurfacing with a scapular-parascapular free flap (the extended scapular flap). The flap was raised in all patients above the deep fascia as a thin skin-subcutaneous tissue flap, providing an initially acceptable aesthetic result. The flap was anastomosed to the facial artery and vein. The donor area was closed directly, or a 4- to 5-cm-wide skin graft was used which could be completely removed in a secondary procedure if the patient requested it. There were four failures early in the series but no losses in the last 70 patients. In order to improve the final aesthetic result, 45 patients underwent complementary defatting procedures (average of three) and Z-plasties initiated 30 days after the initial surgery at intervals of 1 month. Analysis revealed 96 percent good aesthetic results (as determined by the cervicomental angle obtained and the subjective opinion of the patients). There were no recurrences of scar contractures, and good function of the neck was regained in the majority of the patients. Anterior neck burn sequelae thus can be safely treated with en block resection and resurfacing using this flap.
86例颈部前部烧伤后遗症患者接受了瘢痕切除术，切除范围达颈部美学单位的边界，并立即采用肩胛旁游离皮瓣（扩展肩胛皮瓣）进行创面覆盖。所有患者的皮瓣均在深筋膜上方掀起，形成薄的皮肤-皮下组织瓣，初步获得了可接受的美学效果。皮瓣与面动脉和面静脉进行吻合。供区直接缝合，或使用4～5厘米宽的皮肤移植片，如果患者有要求，可在二期手术中完全切除。该系列早期有4例失败，但最后70例患者无皮瓣丢失。为了改善最终的美学效果，45例患者接受了补充性去脂手术（平均3次），并在初次手术后30天开始进行Z成形术，间隔1个月进行一次。分析显示，96%的患者获得了良好的美学效果（根据所获得的颈颏角和患者的主观意见确定）。瘢痕挛缩没有复发，大多数患者颈部功能恢复良好。因此，采用该皮瓣整块切除并覆盖创面可安全治疗颈部前部烧伤后遗症。
