[Clinical effects of expanded flaps in reconstructing scar contracture deformities in the face and neck after extensive burns].

Q3 Medicine
W Zhang, W D Zhang, L Chen, X G Luan, F Yang, Z Li, F Liu, D Y Wang
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引用次数: 0

Abstract

Objective: To investigate the clinical effects of expanded flaps in reconstructing scar contracture deformities in the face and neck after extensive burns. Methods: A retrospective observational study was conducted. From May 2016 to September 2022, 17 patients with scar contracture deformities in the face and neck after extensive burns were admitted to Tongren Hospital of Wuhan University & Wuhan Third Hospital, including 13 males and 4 females, aged 23 to 55 years, with 3 patients having degree Ⅱ cervical contracture, 14 patients having degree Ⅲ cervical contracture, and 12 patients having facial scar contracture deformity. In the first stage, 34 rectangular skin and soft tissue expanders (hereinafter referred to as expanders) with rated capacity of 100-600 mL were inserted into the face, chest, shoulder, and abdomen, and then the normal saline was injected for expansion. In the second stage, the scar tissue was removed and the contracture was released to correct the deformity. Two expanded facial flaps were transplanted in local fashion, 17 expanded flaps were transplanted in pedicled fashion, and 15 expanded flaps were freely transplanted to repair the secondary wounds after release, with artery pressurization was performed in 7 flaps. Indocyanine green fluorescence imaging was used to evaluate the arterial blood perfusion and venous return of the flaps during transplantation. The incision area of 32 flaps except 2 facial flaps was 10 cm×8 cm-36 cm×16 cm. The wounds of 31 flap donor sites were closed by direct suture, and the wound of 1 flap donor site was repaired by autologous split-thickness scalp transplantation. The skin condition of inserted place, expansion time, and total amount of normal saline injection of expanders, complications of skin and soft tissue expansion surgery, and survival of flap after the second stage surgery were observed and recorded. The long-term face and neck reconstruction effect and recovery of flap donor area were followed up. At the last follow-up, the 5-level Likert scale was used to evaluate the efficacy satisfaction of patients. Results: Of the 34 expander inserted places in 17 patients, 22 places were superficial scar skin after deep partial-thickness burns, 8 places were superficial scar skin after multiple skin donations, and 4 places were normal skin. After 4 to 15 months of expansion, the total normal saline injection volume was 238 to 2 000 mL, with no complications occurred. After the second stage surgery, the distal part of 2 pedicled flaps was partially necrotic, and the necrotic wounds were healed after flap dressing and free transplantation of contralateral expanded triangular flaps, respectively; the other flaps survived completely. During 6 to 18 months of follow-up, except for 2 expanded paraumbilical flaps and 1 expanded groin flap, which were bloated and improved by flap thinning, the appearance and texture of the other flaps were good, and all the flap donor sites recovered well. At the last follow-up, the face and neck scar contracture deformities were significantly improved in all patients, and the satisfaction of curative effect of patient was very satisfactory in 8 patients and relatively satisfactory in 9 patients. Conclusions: The expanded flaps of chest, abdomen, and other parts, combined with local advance, pedicled, and free transplantation, can effectively reconstruct scar contracture deformities in the face and neck after extensive burns, restore the function of operative area and improve the appearance simultaneously, with high degree of patient satisfaction, which is worthy of promotion in clinic.

[扩张皮瓣修复面部和颈部大面积烧伤后瘢痕挛缩畸形的临床疗效]。
目的:探讨扩大皮瓣在大面积烧伤后面部和颈部瘢痕挛缩畸形重建中的临床效果。方法:采用回顾性观察研究。2016年5月至2022年9月,武汉大学同仁医院和武汉市第三医院收治了17例大面积烧伤后面部和颈部瘢痕挛缩畸形患者,其中男性13例,女性4例,年龄23~55岁,其中Ⅱ度颈部挛缩3例,Ⅲ度颈部挛缩14例,面部瘢痕挛缩畸形12例。在第一阶段,将34个额定容量为100-600mL的矩形皮肤和软组织扩张器(以下简称扩张器)插入面部、胸部、肩部和腹部,然后注射生理盐水进行扩张。在第二阶段,去除疤痕组织并释放挛缩以矫正畸形。面部扩张皮瓣局部移植2例,带蒂扩张皮瓣移植17例,游离扩张皮瓣移植15例,修复松解后的继发性创面,其中7例进行动脉加压。应用吲哚青绿荧光成像评价移植过程中皮瓣的动脉血流灌注和静脉回流。除2个皮瓣外,32个皮瓣的切口面积为10cm×8cm-36cm×16cm。31个皮瓣供区的伤口采用直接缝合法闭合,1个皮瓣供点的伤口采用自体中厚头皮移植修复。观察并记录第二阶段手术后皮瓣的植入位置、扩张时间、扩张器生理盐水注射总量、皮肤和软组织扩张手术的并发症以及皮瓣的存活情况。随访远期面颈部重建效果及皮瓣供区恢复情况。在最后一次随访中,使用5级Likert量表来评估患者的疗效满意度。结果:在17例患者的34个扩张器插入部位中,22处为深部部分厚度烧伤后的浅表瘢痕皮肤,8处为多次皮肤移植后的浅部瘢痕皮肤,4处为正常皮肤。扩张4至15个月后,生理盐水总注射量为238至2000 mL,未发生并发症。二期手术后,2个带蒂皮瓣远端部分坏死,坏死创面分别经皮瓣包扎和对侧扩张三角皮瓣游离移植后愈合;其他皮瓣完全成活。在6至18个月的随访中,除了2个扩张的脐旁皮瓣和1个扩张的腹股沟皮瓣因皮瓣变薄而肿胀和改善外,其他皮瓣的外观和质地良好,所有皮瓣供区恢复良好。在最后一次随访中,所有患者的面部和颈部瘢痕挛缩畸形都得到了显著改善,8例患者对疗效的满意度非常满意,9例患者对治疗效果的满意度相对满意。结论:胸、腹等部位扩张皮瓣结合局部推进、带蒂、游离移植,可有效重建大面积烧伤后面部、颈部瘢痕挛缩畸形,恢复手术区功能,同时改善外观,患者满意度高,值得临床推广。
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来源期刊
自引率
0.00%
发文量
8511
期刊介绍: The Chinese Journal of Burns is the most authoritative one in academic circles of burn medicine in China. It adheres to the principle of combining theory with practice and integrating popularization with progress and reflects advancements in clinical and scientific research in the field of burn in China. The readers of the journal include burn and plastic clinicians, and researchers focusing on burn area. The burn refers to many correlative medicine including pathophysiology, pathology, immunology, microbiology, biochemistry, cell biology, molecular biology, and bioengineering, etc. Shock, infection, internal organ injury, electrolytes and acid-base, wound repair and reconstruction, rehabilitation, all of which are also the basic problems of surgery.
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