“接力皮瓣”在皮肤软组织扩张术修复严重烧伤瘢痕中的应用

组织工程与重建外科杂志 ›› 2023, Vol. 19 ›› Issue (2): 135-.

“接力皮瓣”在皮肤软组织扩张术修复严重烧伤瘢痕中的应用

出版日期:2023-04-01 发布日期:2023-05-09

Application of sequential expanded flap in reconstruction of severe burn scars

Online:2023-04-01 Published:2023-05-09

摘要/Abstract

摘要：

目的　探讨“接力皮瓣”在皮肤软组织扩张术修复严重烧伤瘢痕中的应用。方法　利用皮瓣“接力”的原

理，在皮瓣供区附近进行接力扩张，用第二个扩张皮瓣产生的组织量来覆盖第一个扩张皮瓣遗留的缺损，将此技术

应用于肩胛背扩张皮瓣修复大面积颏颈粘连。主皮瓣为携带旋肩胛动脉与颈浅动脉双重血供的轴型皮瓣，经软组织

扩张后形成大面积皮瓣，以携带颈浅动脉穿支的肩部皮肤为蒂，旋转至前胸部与颈前区，修复颏颈 / 颏胸粘连的大

面积瘢痕。接力皮瓣的扩张器埋置在主皮瓣下方的腰背部，以携带穿支的螺旋桨皮瓣方式或随意皮瓣方式，向上

方转位修复肩胛部供区缺损。结果　共 12 例患者纳入本研究，男 9 例，女 3 例，年龄 5~45 岁（平均 24.7 岁），

均为烧伤后大面积颈胸部瘢痕挛缩。肩胛区扩张器 300~800 mL，腰背部扩张器 80~300 mL。肩胛区扩张皮瓣面

积 430~840 cm2 ，腰背部接力扩张皮瓣附近可探及 1~4 支肋间后动脉穿支（平均 2.3 支），通常设计以此为蒂的螺旋

桨皮瓣旋转修复肩胛部供区。术后随访 9~40 个月，所有患者颏颈粘连均未复发，颈部皮肤外形及质地良好，背部

供区直接闭合，遗留线状瘢痕。结论　接力扩张技术能最大限度提供皮肤软组织修复所需的组织量，减少手术次数

和供区损伤，尤其适用于颈前区大面积瘢痕创面的修复。

关键词:

接力皮瓣 , 　皮肤扩张术 , 　颏颈粘连

Abstract:

Objective　To explore the application of sequential expanded flap in reconstruction of severe burn scars.

Methods　Using the principle of“sequential”

skin flap, the adjacent area of the skin flap donor site was expanded, and the

tissue generated by the second expansion flap was used to cover the defect left by the first expansion flap. This technique was

applied to repair large area of extensive adhesions between the chin and neck using dorsal scapular flap. The main flap was an

axial flap with a dual blood supply from the ascending scapular artery and the superficial cervical artery. After soft tissue expan

sion, a large skin flap was formed, and the skin on the shoulder carrying the superficial cervical artery perforator was used as the

pedicle to rotate the flap to the anterior chest and neck to repair extensive scars of adhesions between the chin and neck/chest.

The expansion device for the relay flap was implanted in the lower back of the main flap, and the defect in the scapular area was

repaired by rotating the spiral propeller flap with perforator or random flap. Results　A total of 12 patients were included in this

study, 9 males and 3 females, aged 5-45 years (mean 24.7 years), all with extensive scars and contractures of the neck and chest

after burns. The size of the scapular expansion device ranged from 300-800 mL, and the size of the sequential expansion device

in the lower back ranged from 80-300 mL. The area of the scapular expansion flap ranged from 430-840 cm2 , and 1-4 intercos

tal perforators were found near the sequential expansion flap in the lower back (mean 2.3 perforators), usually used to rotate the

李华, 肖文天, 许恒, 等.

“接力皮瓣”在皮肤软组织扩张术修复严重烧伤瘢痕中的应用

[J]. 组织工程与重建外科杂志, 2023, 19(2): 135-.

LI Hua, XIAO Wentian, XU Heng, et al.

Application of sequential expanded flap in reconstruction of severe burn scars [J]. Journal of Tissue Engineering and Reconstructive Surgery, 2023, 19(2): 135-.