张永生 李鹏飞 华英 敖建萍 吐逊阿依

[摘要]目的：探讨双侧颞浅动静脉额部扩张皮瓣修复颌面部瘢痕手术方法改进及效果观察。方法：2011年5月-2018年5月，笔者医院收治9例颌面部瘢痕患者，一期额部预置皮肤扩张器，二期双颞浅动脉皮瓣治疗颌面部瘢痕，分别采用双轴型皮瓣、岛状皮瓣与轴型皮瓣联合二期原位修复。结果：9例皮瓣术后成活良好，有2例因切取皮瓣略大，额部剩余皮瓣和头皮强行拉拢，部分皮缘坏死，经换药后愈合。本次改进方法二期即可修复，极大地缩短了治疗时间。结论：颞浅动静脉额部扩张皮瓣二期修复颌面部瘢痕是一条可行的途径，缩短了手术时间，减少了患者的治疗费用，值得推广。

[关键词]瘢痕;颌面部;颞浅动静脉皮瓣;皮肤扩张器;轴型皮瓣;岛状皮瓣

[中图分类号]R619+.6    [文献标志码]A    [文章编号]1008-6455（2021）05-0019-03

Repair of Maxillofacial Scar with Expanded Forehead Flap with Bilateral Superficial Temporal Artery and Vein

ZHANG Yong-sheng，LI Peng-fei，HUA Ying，AO Jian-ping，TUXUNAYI

（Department of Burn and Plastic Surgery，the 951rd Hospital，Korla 841000，Xinjiang，China）

Abstract： Objective  To explore the improvement and effect of bilateral superficial temporal artery and vein forehead expanded flap in repairing maxillofacial scar. Methods  A total of 9 cases maxillofacial scar patients were treated in our hospital from May 2011 to May 2018. In the first stage， a skin expander was placed in the forehead， and in the second stage， a double superficial temporal artery flap was used to treat the maxillofacial scar. The two-stage in situ repair was performed by using the biaxial flap， island flap and axial flap. Results  9 flaps survived well. Two of them were healed after dressing change because the flap was slightly larger and the remaining forehead flap was forced to close with the scalp. The improved method can be repaired in the second stage， which greatly shortens the treatment time. Conclusion  Superficial temporal predilation flap in second stage is a feasible approach to treat maxillofacial scar. This method shorten the operation time and reduce the treatment cost， which is worth promoting.

Key words： scar; maxillofacial; superficial temporal arteriovenous flap; skin expander; axial flap; island flap

颌面部瘢痕是面部烧伤常见的并发症，损毁患者容貌，给患者心理健康及日常生活带来极大影响，需要通过整形手术修复。2011年5月-2018年5月，笔者单位收治9例颌面部瘢痕患者，采用一期皮肤扩张器额部预置，二期双颞浅动脉皮瓣修复，采用双侧轴型皮瓣，岛状皮瓣与轴型皮瓣联合二期原位转移修复，手术两期即可完成，术后外形逼真自然，效果满意，现报道如下。

1  資料和方法

1.1 临床资料：患者均为男性，年龄20～45岁（平均年龄32岁），均为颌面部烧伤后瘢痕，均以下颌处为主要瘢痕部位，其中4例为双侧面颊部有瘢痕，5例单侧面颊部有瘢痕。

1.2 手术方法

1.2.1 一期手术（额部皮肤扩张器置入）：患者取仰卧位，麻醉起效后，切口选择位于前额正中发际线后约1～2cm处，置入扩张器于额肌下。……