利用拉伸皮瓣重建烧伤后面部畸形

O. Zhernov, G. P. Kozynets
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摘要

目标。改善面部烧伤后畸形患者的手术治疗结果,最大限度地恢复主要部位的皮肤覆盖物,最佳地应用邻近部位的拉伸组织。材料和方法。调查纳入了2009 - 2019年治疗的37例患者,其中23例男性和14例女性,年龄在10 - 62岁之间(中位年龄为25.7岁)。对于面部缺损,应用伸展额瓣(5),外侧和下面瓣(4),下颌下和下颌下颈(8),颈(7)和颈颈臂瓣(16)。在2例双侧病变患者中,双侧应用颈肱颈皮瓣。结果。所有的皮瓣都以根为主。4例患者术后第24小时出现颈、颈肱皮瓣静脉充血,应用抗凝剂后静脉充血消失。评价治疗远期效果的主要标准是瘢痕切除的完整性、继发畸形的发生和面部主要轮廓的恢复。对17例患者的远程结果进行了研究,估计效果良好。在其他患者中,结果是未知的。结论。根据疤痕缺陷的定位和面部和颈部不同解剖区域中未受影响组织的存在,可以应用拉伸皮瓣,这允许获得足够数量的具有接近缺陷的纹理特性的可行塑料材料。在面部和颈部的不同解剖区域使用拉伸皮瓣,在近期和远期观察均取得了良好的效果。
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Reconstruction of post–burn facial deformities, using stretched flaps
Objective. Improvement of the surgical treatment results in patients with post-burn deformities of the face, using maximal restoration of cutaneous coverings of principal parts with optimal application of stretched tissues in adjacent places. Materials and methods. Into the investigation were included 37 patients, who were treated in 2009 - 2019 yrs,23 men and 14 women, ageing 10 - 62 yrs old (median age have constituted 25.7 yrs old). For facial defects plasty were applied the stretched frontal flap (5), lateral and lower facial flaps (4), submandibular and submandibularly-cervical (8), cervical (7) and cervical and cervico-brachial flaps (16). In 2 patients with bilateral affection the cervical and cervico-brachial flaps were applied on both sides. Results. All the flaps applied took the root primarily. During first postoperative 24 h in 4 patients venous congestion in cervical and cervical-brachial flaps was noted, which have disappeared after application of the antiaggregate preparations. Main criteria of estimation of the treatment far remote results were: the completeness of the cicatrices excision, the secondary deformity occurrence and restoration of the face main contours. Far emote results were studied in 17 patients and were estimated as good. In other patients the result is unknown. Conclusion. Depending on the cicatricial defect localization and presence of unaffected tissues in various anatomical zones of the face and neck, application of the stretched flaps is possible, what permits to obtain a sufficient quantity of viable plastic material with textural properties, which are close to defect. Using stretched flapsin various anatomical zones of face and neck good result was obtained in immediate and far remote periods of observation.
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