上臂内侧扩张皮瓣修复面部大面积瘢痕和黑痣(1)
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[摘要]目的：介绍上臂内侧扩张皮瓣修复面部瘢痕、黑痣的方法。方法：2009年12月～2011年7月，共16例面部大面积瘢痕或黑痣患者采用上臂内侧皮瓣进行修复，其中面部瘢痕患者14例，面部黑痣2例，男性13例，女性3例，年龄18～36岁。手术分三期进行，一期在面部病变同侧上臂植入扩张器，持续注水约3个月，二期行皮瓣延迟术，三期将上臂内侧皮瓣带蒂转移，病变切除。四期断蒂。结果：16例患者皮瓣均成活良好，皮瓣颜色接近面部周围皮肤，局部瘢痕牵拉畸形者亦改善明显，随访6～12个月，修复效果满意。结论：上臂内侧皮瓣为修复面部大面积皮肤病变的良好选择。
[关键词]上臂内侧皮瓣；扩张器；面部瘢痕；面部黑痣
[中图分类号]R622 [文献标识码]A [文章编号]1008-6455(2012)02-0196-03
Application of medial upper arm flap in the treatment of large area of scar and black nevus on face
YU yan1,XU Hong-xia1,ZOU Yue-kun2
(1.Depatment of Plastic Surgery,2.Health Department,Navy General Hospital,Beijing 100048,China)
Abstract: Objective To introduce the application of medial upper arm flap in the treatment of large area of scar and black nevus on face. Methods From December 2009 to July 2011, 16 patients with large area of scar and black nevus on face were performed face reconstruction using medial upper arm flap. Of all the cases,14 patients were diagnosed as scar on face,2 patients were diagnosed as black nevus on face. 13 patients were male,3 patients were female,ranging in age from 18 to 36. A tissue expander was placed in the medial arm region and serially inflated for approximately 3 months. Second,delaying of skin flap was performed. Then,the pedicle skin flap was transferred to the face. The pedicle was divided 3 weeks later, and the flap was used to resurface the facial defect. Results All the flap were safely transferred. The color of the flap was close to the surrounding skin. The dragging deformity by scar were corrected. With 6 to 12 months' follow-up, the appearance were good. Conclusion Medial upper arm flap was a good option for reconstruction of massive facial defects.
Key words: medial upper arm flap; expander; facial scar; facial black nevus
面部小面积的瘢痕、黑痣可以通过直接切除或转移临位皮瓣的方法治疗，但是大面积瘢痕、黑痣，无法通过上述方法治疗，上臂内侧皮瓣通过扩张可以提供较大面积组织修复面部皮肤病变切除后留下的缺损，同时皮肤质地、颜色接近面部，因而在修复面部皮肤病变方面不失为较好的选择。
1 资料和方法
1.1 研究对象：本组共16例患者，男性13例，女性3例，年龄18～36岁。烧烫伤后遗留瘢痕者14例，面部黑痣者2例。病变面积最小者6cm×8.5cm，病变面积最大者13cm×10cm。同时伴有下睑外翻者3例，鼻翼畸形者1例，口角粘连者2例。病变均无法通过直接切除或在周围正常皮肤埋置扩张器的方法解决。
1.2 手术方法
1.2.1 一期扩张器植入术：在与面部病变同侧的上臂内侧埋置扩张器，扩张器容量在400～600ml，切口设计在扩张器的侧面，长约8cm，局部麻醉后在深筋膜浅层钝性剥离，下端至肘横纹上5cm，上端至腋窝下，剥离出与扩张器等大的腔隙，彻底止血后植入扩张器及注水壶。分层缝合关闭切口，术中注入扩张器容量10%的生理盐水。略加压包扎。术后2周拆线并注水，每周两次，每次根据扩张皮瓣的张力和颜色决定注水量。一般注水时间为3个月，注水总量为800～1300ml，注水完成后静止扩张1周。
1.2.2 二期行皮瓣延迟术：局部麻醉后沿一期手术切口切开皮肤、皮下组织及包膜，并向上向下延伸至扩张器侧缘全长，取出扩张器，将扩张皮瓣向外牵拉至切口能够关闭的位置 ......
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