应用皮肤软组织扩张术修复面部皮肤缺损
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[摘要]目的：探讨皮肤软组织扩张术用于面部皮肤缺损美容修复的临床应用价值。方法：I期手术根据32例面部组织病损修复需要的不同特点设计并制作扩张皮瓣，II期手术切除皮损区域并利用扩张皮瓣修复缺损区。结果：32例中，30例面部病损切除后利用扩张皮肤形成局部皮瓣一次完成修复，修复后的皮肤质地和色泽与受区接近，外形满意。一次修复缺损创面最大者约7cm×10cm。患者修复后皮损区愈合良好，瘢痕较小，功能恢复良好，效果满意。结论：运用皮肤扩张术修复面部病损切除后的皮肤缺损是一种较为理想的修复方法，在某些特殊情况下，可能还需要辅助植皮或应用连续扩张法完成修复。面部皮肤扩张技术的应用，使该区域的修复达到更接近正常的效果。
[关键词]皮肤软组织扩张术；面部组织缺损；皮瓣；修复术
[中图分类号]R622 [文献标识码]A [文章编号]1008-6455(2011)06-0914-02
Clinic application of skin soft tissue expansion in cosmetic repair of facial tissue defects
ZHAO Zhi-li,GU Ting-min,SUI Zhi-fu,LI Li,SHI Cheng-fang,CHANG Dong-qing,YANG Rong-ya
(Laser & Aesthetic Surgery Center,Dermatology Institute,General Hospital of Beijing Military Command, Beijing 100125,China)
Abstract:ObjectiveTo investigate the clinical value of facial cutaneous lesions by capacity tissue expansion.MethodsWe designed and made the expanding flap according to the different characteristics and requirements of the 32 patients during the first period of their treatment. During the second period, we cut away the damaged skin and used the skill of expanding flap to repair the damaged part.ResultsThirty in 32 cases underwent successful expanded flap correction of defects after skin lesion removing, with maximal defect being 7cm by 10cm in size. All of the patients obtained less scar which are not obviously seen, restored good function, the result is satisfactory.ConclusionSkin expansion is a good choice for correction of defects due to facial cutaneous lesion removing. Splitting skin grafting and sequential skin expansion are necessary when defect is too large to correct or expanded flap is not large enough. The application of expanding the skin of the face make the part to close more to the effect of the normal state after repaired.
Key words:skin soft tissue expansion; facial tissue defect; flap; repair operation
面部皮肤缺损因为面部的特殊性，无论性质与大小，外科手术都不可能回避美容问题，因而对手术修复要求较高--既要瘢痕少而隐蔽，又要缺损修复后的皮肤在色泽、质地等方面与受区接近[1-3]。对于不能单纯应用局部皮瓣完成修复的病例，目前只有利用皮肤扩张术能较好地达到这两方面的美容修复要求。笔者在临床工作中采用皮肤扩张术，不但获得了质地匹配的“额外”皮肤组织，而且修复后切口无张力，远期切口瘢痕不明显，临床效果明显优于传统的方法。
1临床资料
1.1 一般资料：2005年3月～2010年11月，我科对32例面积较大的面部皮肤缺损进行软组织扩张手术修复，其中男14例，女18例，年龄10～55岁，瘢痕18例，色素痣7例，血管瘤5例，疣状痣2例。平均皮肤缺损面积20.2cm2，扩张最大面积达70cm2。同时埋置4个扩张器1例，同时埋置3个扩张器3例，同时埋置2个扩张器14例 ......
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