曹林 席庆春 方明松 李旋 赵玲玲

[摘要]目的：探讨局部皮瓣美容修复面部皮肤软组织缺损的临床效果。方法：选取2016年2月-2019年10月收治的头面部肿物、瘢痕、外伤患者60例，根据面部软组织缺损部位、面积设计局部皮瓣美容修复，观察患者皮瓣修复效果、心理变化及患者满意度及复發情况。结果：皮瓣成活良好切口愈合，术后患者SDS评分、SAS评分均低于术前，差异有统计学意义（P<0.05）。随访12个月，58例患者的皮瓣与周边皮肤组织厚度、色泽无明显差异，无牵拉及不对称，外观与功能修复效果满意，满意度为96.67%;仅2例患者复发，复发率为3.33%。结论：局部皮瓣美容修复面部皮肤软组织缺损，操作简单，修复皮瓣的性状与缺损处相似，瘢痕小，安全性高，患者满意度高，值得临床应用。

[关键词]局部皮瓣;面部皮肤肿瘤;软组织缺损;创面修复;存活率

[中图分类号]R622    [文献标志码]A    [文章编号]1008-6455（2021）07-0015-03

Application of Local Flap in the Repair of Facial Soft Tissue Defect

CAO Lin，XI Qing-chun，FANG Ming-song，LI Xuan，ZHAO Ling-ling

（Department of Burn and Plastic Surgery，the Second People's Hospital of Hefei，Hefei 230000，Anhui，China）

Abstract： Objective  To investigate the clinical effect of local skin flap in cosmetic repair of facial skin and soft tissue defect. Methods  Sixty patients with head and face masses， scars and trauma admitted from February 2016 to October 2019 were selected. According to the site and area of facial soft tissue defect， local skin flap was designed for cosmetic repair， and the effect of skin flap repair， psychological changes， patient satisfaction and recurrence were observed. Results  The flap were survived and the incisions were well healed among patients， postoperative scores of SDS and SAS were lower in patients compared to preoperative scores， the differences were statistically significant （P<0.05）. After 12 months of follow-up， there was no significant difference in thickness and color between the flap and the surrounding skin tissue in 58 patients. No pull and asymmetric were found. The satisfaction degree of appearance and function restoration was 96.67%， only two patients relapsed and the recurrence rate was 3.33%. Conclusion  The local skin flap could be used for cosmetic repair of facial skin and soft tissue defect. The thickness and color of the skin flap are similar to the defect. Patients had small scar. The local skin flap had high level of safety and satisfaction. It is suggested for further clinical application.

Key words： local flap; facial skin tumor; soft tissue defect; wound healing; survival rate

一般造成面部软组织受损的因素为皮肤肿物、外伤、瘢痕等，其不仅影响患者面部美感，同时严重影响患者心理健康[1]。面部皮肤软组织缺损的美容修复原则是将患者的负面情绪降至最低，以此原则为基准，选择较好的手术修复方案，应用局部皮瓣修复软组织缺损创面的正常形态及功能。因皮肤肿物、外伤、瘢痕等造成的头面部缺损的患者进行局部皮瓣修复术，患者依从性高，外形恢复效果好，现报道如下。

1  资料和方法

1.1 一般资料：本组共60例患者。男性31例，女性29例;年龄2～89岁;缺损原因：色素痣26例，皮肤恶性肿瘤12例，皮肤坏死9例，皮肤角化5例，外伤5例，瘢痕3例;缺损部位：面颊部17例，头皮9例，眶周8例，颞部7例，颈部7例，额部6例，唇部3例，鼻部3例。纳入标准：①本研究经医院伦理委员会批准;②患者一般资料齐全并确诊;③有明确外伤史，治疗过程中依从性高。排除标准：①凝血功能障碍者;②存在心肝肾功能不全者;③存在精神疾病无法言语沟通者。……