Limberg皮瓣在面部缺损创面修复中的应用(1)
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[摘要]目的：观察Limberg皮瓣修复面部缺损创面的效果。方法：9例面部肿物切除后皮肤软组织缺损患者设计Limberg皮瓣修复创面。其中肿瘤患者3例；色素痣患者6例。结果：9例患者术后皮瓣均未出现动脉供血和静脉回流障碍，皮瓣色泽、质地较好；伤口Ⅰ期愈合，随访3～6月未见肿物或色素痣复发，瘢痕不明显，形态满意。结论：Limberg皮瓣修复面部中小缺损创面效果良好。设计原则包括：将旋转瓣设计在临近皮肤最松弛区域并且最好完整覆盖一个凸出的美学单位；如果局部旋转后发生猫耳畸形，可以使用皮下蒂皮瓣或者改良的Limberg皮瓣(DuFourmentel皮瓣)；如缺损为圆形，用阅读者皮瓣(the reading man procedure)效果可能更好。
[关键词]面部；缺损；Limberg皮瓣
[中图分类号]R622 [文献标识码]A [文章编号]1008-6455(2012)02-0181-03
Application of the flaps of limberg in reconstruction of facial skin defect
JIN Ji,LIU Yuan-bo,SONG Bin,ZHU Shan,ZANG Meng-qing,LIU Dong-hong
(The 11th department of Plastic Surgery Hospital,Chinese Academy of Medical Sciences ＆ Peking Union Medical College,Beijing 100144,China)
Abstract: Objective To explore the ideal way of using the flaps of Limberg in reconstruction of facial skin defect. Methods 9 cases were diagnosed as skin cancer or nevus of the face on the pathological examination.They were resected and reconstructed using the flaps of Limberg. Results All wounds healed by first intention without venous congestion or infection of the flaps.The color,texture and contour matched well with the face. The incisions were along the margin of the facial aesthetic unit, leaving inconspicuous scars.During 3 to 6 months of follow-up，no tumor or nevus recurred.Doctors and patients are satisfied with the results. Conclusion The flaps of Limberg is a safe and effective procedure for correction of facial skin defect.However, Several principles should be followed when applying the flap. The rotational flap should be designed in the most flexible area and covered an entire aesthetic unit to take the advantage of The Trap Door Deformity. To avoid "Dog ear deformity",subcutaneous pedicle could be employed. If the defect is round,the reading man procedure would be more efficient and preferably.
Key words:facial skin defect;flaps of limberg
面部皮肤肿瘤和色素痣的切除修复是整形医生的日常工作之一。当病变面积偏大或与五官邻近时，修复往往有一定难度。鼻下半部皮肤较厚，腺体丰富而缺少弹性，处理该部位的病变也比较困难。Limberg皮瓣自1966年报道以来[1]，临床用于治疗中度、不适合直接缝合的皮肤软组织缺损非常有效[2]。
面部皮肤肿瘤以基底细胞癌和鳞状上皮细胞癌常见，切除后形成的缺损修复要求较高。直接拉拢缝合往往会造成面部器官的变形移位，而皮片游离移植因晚期色素沉着及皮片挛缩等缺点也不为患者接受。我科自2009年6月～2011年6月应用Limberg皮瓣修复面部皮肤缺损9例 ......
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