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Objective:To investigate the efficacy of tumescent anesthesia combined with skin and soft tissue expansion for the repair of congenital giant melanocytic nevi.Methods:From July 2015 to December 2019, 41 patients with congenital giant melanocytic nevi, including 24 males and 17 females aged 7 - 45 years, were collected from the Department of Dermatology, Xijing Hospital, the Fourth Military Medical University. Skin lesions ranged from 5 cm × 12 cm to 12 cm × 18 cm in size, and were located on the scalp in 13 cases, on the face in 18 cases, as well as on the trunk in 10 cases. Before surgery, the composition of tumescent solution was adjusted according to the body weight, operation duration, skin lesion area, etc., and the total dose and peak plasma concentration of lidocaine should be below 35 mg/kg and 4 mg/L respectively. All the patients received tissue expander placement and second-stage flap transfer under tumescent anesthesia.Results:During surgery, satisfactory effect of tumescent anesthesia was achieved in all the 41 patients, the pain score assessed by a numerical rating scale was 1.82 ± 0.54. In addition, the surgical field and dissection levels were clear with little bleeding and no related complications. Follow-up of 3 - 36 months showed that the skin flaps matched the surrounding skin tissues well, with relatively concealed incision lines and soft flat scars.Conclusion:For the treatment of congenital giant melanocytic nevi, tumescent anesthesia is effective and safe, which combined with skin and soft tissue expansion can effectively reduce the incidence of postoperative complications, and this strategy is worthy of clinical promotion.
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Objective@#To explore the clinical effects and key techniques of expanded super-thin perforator flaps in the shoulder, neck, and chest in reconstruction of extensive burn scars in the face.@*Methods@#From January 2008 to November 2018, 22 patients with extensive burn scars in the face were admitted to the Department of Plastic Surgery of Dongguan Kanghua Hospital and the Department of Plastic Surgery of Dermatology Hospital of Southern Medical University, with 3 males and 19 females, aged from 4 to 48 years. There were 16 cases of type Ⅱ and 6 cases of type Ⅲ in facial scars. Before the first stage of expansion surgery, Doppler blood flow survey meter or multi-slice CT was used to locate the perforator vessels. One to four expanders with rated capacity ranged from 100 to 600 mL were placed in the patients. We gave 20% to 30% of the rated capacity of expander intro-operation and common injection with 10% to 15% of the rated capacity of expander per week post-operation until the volume reached 1.5 to 2.5 times of the rated capacity of expander during the past 3 to 4 months. At the second stage of surgery, the perforators were located again before surgery with the same method. The size of defects after the excision of facial scars ranged from 6 cm×4 cm to 18 cm×16 cm. With perforators used as nutrient vessels, narrow pedicle flaps or random flaps ranging from 6 cm×6 cm to 22 cm×18 cm were elevated as rotating or advancing to reconstruct the defects. The donor sites were sutured directly. Some of the flaps needed stage Ⅲ operation for cutting the pedicle. The survival of flaps, post-operation complications, and follow-up were assessed.@*Results@#All flaps of 22 patients survived. All the donor sites were closed simultaneously. One patient underwent an additional surgery for 5 cm×4 cm necrosis on distal part of flap caused by subcutaneous hematoma. Two patients with epidermis blister on the flaps were healed by themselves after dressing change. Due to rapid expansion, blood capillary proliferation appeared on the central part of the flap in 3 cases, after slowing down the expansion speed properly, which had no impact on flap transfer. No ischemia or venous congestion phenomenon were observed in the other flaps. During follow-up of 5 to 48 months, the flaps of patients showed no significant bloated appearance, with good complexion and texture, and even could reproduce facial fine-grained expressions naturally.@*Conclusions@#For the reconstruction of extensive burn scars in the face, expanded super-thin perforator flaps can not only acquire large and thin flaps with high matching degree surface skin defect, but also reproduce facial fine-grained expressions. It is a simple and safe method which conforms to the facial aesthetic standard.
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Objective@#To explore the feasibility and technical points of soft tissue defect reconstruction using the pedicled anterolateral thigh flap based on perforating vessels from the lateral circumflex femoral artery oblique branch.@*Methods@#Between November 2009 and April 2019, 27 pedicled anterolateral thigh flaps were performed to repair the wound of trunk and lower extremity, based on perforating vessels from the lateral circumflex femoral artery oblique branch. 16 flaps were proximally based and 11 were distally based.@*Results@#The proximally based flap ranged from 15 cm×8 cm to 32 cm×12 cm. The mean length of the pedicle was 8.2 cm. The distally based flap ranged from 9 cm×7 cm to 24 cm×8 cm. The mean length of the pedicle was 18.6 cm. All flaps survived after surgery. Venous congestion occurred in one flap and relieved in five days.@*Conclusions@#With oblique branch as the pedicle, the vascular dissection was easy and donor site morbidity was minimized while harvesting the proximally based anterolateral thigh flaps; long pedicle could be obtained, and the reconstructive sphere was extended when using the distally based anterolateral thigh flaps.
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Objective@#The incidence of complications after skin soft tissue expansion is relatively high. Occurrence of infection often means the expander has to be taken out ahead of schedule. In this retrospective study, we wanted to identify independent risk factors of infection after skin soft tissue expansion, which could be helpful to guide clinical work.@*Methods@#Demographic information of patients who underwent the skin soft tissue expansion at the department of plastic surgery of Xijing Hospital from January 2003 to December 2012 was collected. Univariate associations with infection were measured by logistic regression and represented as odds ratios. The p-value less than 0.1 was identified the potential risk factor. Multivariate logistic regression was used to calculate odds ratios for risk factors of infection. Independent risk factors were identified if the p-value was less than 0.05.@*Results@#A total of 3382 implants were included in the study. The overall infection rate of tissue expansion was 5.2% in 177 implants. The result of multivariate logistic regression showed that preoperative white blood cell count, age, numbers of expander implanted and volume of expander were independent risk factors of infection.@*Conclusions@#Independent risk factors of infection were preoperative white blood cell count, age, numbers of expander implanted and volume of expander. The lower preoperative white blood cell count, age more than 18 years old, more numbers of expander implanted and the bigger volume of the expander, the higher possibility of complications occurred. The result was helpful to guide clinical work and reduce the incidence of infection.
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Objective@#To investigate the functional recovery and cosmetic effects of pre-expanded pedicled deltopectoral flap.@*Methods@#From January 2008 to December 2018, 42 patients with 56 pre-expanded pedicled deltopectoral flaps from Xijing Hospital of Air Force Military Medical University were followed up at least 6 months. 18 of them were male, the remaining were female. And the average age was (24.7±7.3) years. Then the indicators were tested and evaluated. Tubes with different temperatures were used for temperature sensation test. The flaps were stabbed using a 27 G blunt needle to test algesthesia. Tactile threshold was measured by Semmes-Weinstein monofilament. Two-point discrimination was measured by Disk-Criminator. Elasticity of skin flaps was measured by CK-MC®960. Colors of skin flaps were analyzed by ANTERA®3D system, including L*a*b*, melanin and hemoglobin content. And the postoperative scars were evaluated by the Patient and Observer Scar Assessment Scale (POSAS). The flap retraction rate [(flap area immediately after operation-flap area at the follow-up time)/flap area immediately after operation]was calculated. The satisfaction of patients, doctors and third parties was investigated as well. Statistical analysis of data was performed with SPSS 23.0, satisfaction rate was expressed as percentages. Scar scores were compared by Wilcoxon rank sum test. The values of elasticity, color L*a*b*, melanin and hemoglobin between skin flaps and normal skin were analyzed by paired t test. The difference was statistically significant at P<0.05.@*Results@#The scores of pain, heat and cold sensation were (4.61±0.78), (3.48±0.90) and (4.39±0.81), the tactile threshold was (0.26±0.23) g/mm2, and the distance of two-point discrimination was (10.09±4.79) mm. There was no significant difference in elasticity, color b*and melanin content between skin flap and normal skin of face and neck (P>0.05). The color of flap L*, a*and hemoglobin content of flaps were significantly different from those of normal skin from face and neck (P<0.05). The result of self-assessment of patients (POSAS) showed that there were significant differences (P<0.05) in pain, itch and stiffness between facial and chest donor scar. The result of observer evaluation (POSAS) showed that the scar score for all items around facial flap was better than that of chest donor area, the difference was statistically significant (P<0.05), and the retraction rate of flaps was (10.44 ±3.36)%. The satisfaction rates of doctors, patients and the third party were 92.86% (39/42), 71.43% (30/42) and 61.90% (26/42), respectively.@*Conclusions@#Excellent functional recovery and reliable cosmetic effect were observed in the facial-cervical scar repair with pre-expanded pedicled deltopectoral flap. Transfer of pre-expanded pedicled deltopectoral flap is an effective method for the treatment of facial-cervical scars.
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As a revolutionary plastic treatment, skin soft tissue expansion has become one of the three conventional techniques of plastic surgery after skin grafting and flap transplantation. At present, expansion is widely used in the treatment of various lesions in multiple parts of the body. It plays an irreplaceable role in many areas such as scar repair, alopecia treatment, ear, nose, breast, penis and other organ reconstruction and surface tumor management. In recent years, the application of expansion has been constantly evolving, and it has renewed its vitality by combining with new technologies. However, the prevention and treatment of complications of expansion should be paid more attention, the expansion efficiency needs to be improved, the basic research on the skin regeneration mechanism and micro-environment changes of expansion is still lacking, and further exploration is needed. Based on this, the clinical application principles, new progress and experimental exploration of skin soft tissue expansion were reviewed and summarized, and the possible development directions were analyzed.
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Objective@#This study aimed to present our clinical experience using a novel method for autologus costal cartilage framework fabricationin fully expansion technique ear reconstruction without skin graft.@*Methods@#During Steptember 2016 to Steptember 2017, autologus costal cartilage framework with expansion technique were performed for 63 patients with microtia. Autologous costal cartilage was stacked up to form the structure and height, the natural appearance of auriculocephalic angle was achieved at the same stage, so the second-stage elevation of ear and postauricular skin graft was unnecessary. The delicate structure of the reconstructed ear and ideal bilateral symmetry were achieved by the optimized cartilage stack-up.@*Results@#Three patients out of total 63 patients had cartilage frame work exposure, and were treated with superficial temporal fascia transfer combined with skin graft. The rest 60 patients had satisfied results. Follow-up ranged from 8 months to 18 months and 12 months follow-up was on average. The novel frame work fabrication method was based on the sufficient full pre-expansion procedure. The ideal structure, bilateral symmetry, and excellent definition of the framework, as well as the natural dorsal appearance of the reconstructed auricular were achieved.@*Conclusions@#The cartilage " stack-up" method is essential for the full expansion without skin grafts ear reconstruction technique. The combination of the cartilage " stack-up" framework fabrication and full pre-expansion provide a well-defined, well-projected and bilateral symmetrical ear.
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Objective@#To investigate the clinical outcomes of skin and soft tissue expansion in the repairment of neck scar.@*Methods@#From March 2009 to May 2018, 15 patients with postburn scar contractures on neck, were admitted to the Department of Burn and Plastic Surgery, Karamay Central Hospital of Xinjiang. The patients include 12 males and 3 females, aged 12 to 48 years, with the mean age of 31 years. The scars were at 9 cm×6 cm-14 cm×11 cm in size. The tissue expander of 100-300 ml was placed subcutaneously, in the normal skin area on neck, on one or each side at the first stage operation. The first expander infusion was performed 10-14 days after surgery. The tissue expansion remains for 3-9 months, with an interval of 10 days of each infusion. After the tissue fully expanded, the expander was maintained for 1 month. At the second stage, the expander was removed, and the expanded flap was transferred to repair the wound.@*Results@#The expander exposure due to friction occurred in 2 patients. The final therapeutic effect was not affected, because of iodine gauze bandage. Blood supply of expanded flaps was good in other patients. The size of the expanded flaps was 12 cm×8 cm-16 cm×15 cm. All flaps survived after the second stage surgery. Patients were followed up for 0.5-5 years after surgery. The color and texture of flaps was similar to adjacent normal skin.@*Conclusions@#Skin and soft tissue expansion is a safe and effective method in repairing neck scar.
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Objective@#To investigate the clinical outcome of expanded frontotemporal flap pedicled with bilateral superficial temporal vessels, in repairing facial and cervical scar contracture deformity.@*Methods@#From January 2012 to December 2017, 12 male patients with severe facial and cervical scar hyperplasia and contracture deformity, ranging from preauricular region, cheek, chin to neck, were treated in the Burn Department of the First People′s Hospital in Zhengzhou. The patients were aged at 15-58 years, with the mean age of 29.3 years. The frontotemporal scalp flaps were simultaneously expanded to prefabricate a flap pedicled with bilateral superficial temporal arteries and veins. The operations were carried out in 3 stages. Stage Ⅰ: A 400-600 ml cylindrical expander was placed in the frontal region, underneath of galea aponeurosis and frontal muscle, meanwhile, a 50-100 ml cylindrical expander was placed in the temporal region on each side, between the deep temporal fascia and temporal muscle. Stage Ⅱ: The expanded flap pedicled with bilateral superficial temporal vessels were received, to repair the secondary wound after scar resection and contracture release. The neck curve was reshaped. The donor area was directly sutured. Stage Ⅲ: The flap pedicle was repaired, and residual scar was removed. Laser hair removal was performed on the skin flaps about 3 weeks after operation.@*Results@#Seven patients underwent simultaneously cervical and thoracic tissue expansion. The expansion time was 5-6 months (average 5.2 months). The expanded flap was 40 cm×9 cm to 45 cm×15 cm in size. All flaps survived. The venous reflux disorder after the second stage operation occurred in 1 patient. The affected area was purple and swollen. It was recovered after acupuncture and compression bandage for 1 week. Laser hair removal was performed in 8 flaps. Flap thinning was performed in 5 flaps. All 12 patients were followed up for 4 to 24 months. The flaps have good appearance, without bloating. The transferred flaps have similar color and texture with adjacent the facial skin. The cervical mobility was significantly improved. The hairline of the head was normal, and the suture scar was slight and concealed.@*Conclusions@#The expanded frontal and temporal flaps provide considerable amount of tissue with thin skin and reliable blood supply. It is an alternative method to repair facial and cervical scar contracture.
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Objective@#To introduce a reconstruction procedure of natural sideburn, with combined expanded retroauricular flap and scalp flap.@*Methods@#A retrospective study was produced in Plastic Surgery Hospital, PUMC, from January 2014 to December 2017. Twenty patients (21 sides) underwent sideburn reconstruction with combined expanded retroauricular flap and scalp flap (double pedicled flap, n=3; single pedicled flap, n=17) were included in this study. There were 12 male (12 sides) and 8 female (9 sides), with the mean age of (23.8±3.2) years. The sideburn defect was caused by burn in 19 patients, and it was resulted from hemangioma in 1 patient.@*Results@#The size of flaps ranges from 8 cm×12 cm to 10 cm×16 cm. Venous congestion at the distal end of the flap occurred in 1 patient, which was cured after dressing change, and the sideburn was not affected. The reconstructed sideburns are natural, symmetric, and without obvious scar. The follow-up time was 3-40 months. Fourteen patients were very satisfied with the reconstructed sideburn, and 6 patients were satisfied. No severe complication was observed during follow-up time.@*Conclusions@#The combined retroauricular flap and scalp flap is an alternative method for sideburn reconstruction, which provide natural hair distribution, inconspicuous scars and less complications.
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Objective@#To explore the clinical application of subpectoral silicone implant associated with autologous fat grafting after tissue expansion, for breast reconstructions.@*Methods@#From Jan 2013 to Dec 2016, a total of 15 female patients were admitted to the plastic surgery department of the First Affiliated hospital of Fujian Medical University. They were after or were prepared to unilateral modified radical mastectomy. Patients were aged 18-50 years old, with the average of 33.5 years. There were 8 cases of T1N0MO (T1micN0MO, n=1), 3 cases of T2N0MO, 1 case of T2N1MO, 1 case of T1N2MO, 1 case of T2N2MO and 1 case of T3N3MO. A tissue expander was inserted beneath the posterior pectoralis major in first surgery. The cavity stripped range is greater than the expander around 1cm. The lowest position of the expander was determined according to the IMF of the other breast. The tissue expander was gradually filled intraoperatively and postoperatively periodically, until the expander exceeds 30%-50% of the volume of the other breast. Three months later, as the soft tissue over the breast area has stretched enough, the expander was removed in a second operation and a permanent implant was inserted. Meanwhile, the autologous fat particles, harvested from thigh or abdomen, was centrifuged at 800×g for 3 minutes. Then it was injected into the subcutaneous and posterior pectoralis major space. And the other breast may be adjusted if necessary for symmetry.@*Results@#Fifteen patients was included in this study (immediately tissue expander implanted, n=8; delayed tissue expander implanted, n=7). All the expanders are round in shape. The interval between the two operations was 6-12 months, with an average of 7.4 months. The total salt-water solution injected was 310-450 ml per patient, with an average of 365 ml. The volume of breast implants was 180-280 ml. The injection volume of autologous fat was 65-230 ml, 122.7 ml on average. All incisions healed well. The follow-up period was 1-3 years, with an average of 2 years. The reconstructed breasts were in a natural shape, with a slight drop and bilateral symmetry. According to Harris breast shape evaluation criteria, all reconstructed breasts were graded as excellent.@*Conclusions@#The permanent implant associated with autologous fat grafting after tissue expansion is alternative for breast reconstruction.
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Objective@#To explore the feasibility and technical tips of defect reconstruction using the pre-expanded perforator propeller (PEPP) flap.@*Methods@#From July 2009 to December 2017, 56 patients underwent defect reconstruction using the PEPP flap. During the first-stage operation, an expander with appropriate size was buried within a soft-tissue pocket. Three strategies were used for expander placement, including placement of the expander underneath the muscle, at a distance from the emergence point of the perforator when the perforator location is relatively fixed, and following the criteria when a free-style perforator flap is designed. At the second-stage operation, a PEPP flap was raised and rotated a certain number of degrees to reconstruct the defect.@*Results@#56 flaps were elevated. The expanders were buried according to the strategy Ⅰ in 2 cases, the strategy Ⅱ in 42 cases, and the strategy Ⅲ in 12 cases. The flap size ranged from 7-13 cm to 14-32 cm with the average size of 9.38 cm × 21.22 cm. The pedicle length ranged from 2.5 cm to 10 cm and the mean length was 5.03 cm. The rotation angle was 180 degrees in 44 cases, 150 and 120 degrees in 6 cases respectively. The perforators that were previously explored were all identified during the second-stage operation. 53 flaps survived completely. Venous congestion of the distal portion of the flap was observed after the surgery in two cases. Necrosis of small area of the flap occurred and free skin grafting was used to resurface the defect after debridement. All patients were followed up for 3 months to 4 years and the average follow-up time was 13.4 months.@*Conclusions@#The PEPP flap can not only ensure primary closure of the donor site, but also provide more extra tissue for defect reconstruction. For selected patients, it could be an alternative option for soft-tissue defect reconstruction.
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Objective@#To investigate the feasibility and technical tips of repairing facial defects with pre-expanded propeller flap based on the perforators of the supratrochlear artery or the supraorbital artery.@*Methods@#In the first-stage operation, a tissue expander was buried underneath the frontalis muscle. The second-stage operation was conducted using pre-expanded supratrochlear artery or the supraorbital artery based propeller flap to repair facial defect.@*Results@#From July 2010 to July 2016, this method was used in 8 patients. 5 flaps were based on the supratrochlear artery, and 3 flaps based on the supraorbital artery. Expander size was ranged from 150 ml to 300 ml. The size of propeller flaps was from 10 cm × 6 cm to 15 cm × 13 cm. All the flaps survived without any major complications. Follow-up period ranged from 3 to 36 months. Eyebrow replacement, flap thinning and scar revision were performed in 6 cases. All patients were satisfied with the final aesthetic result.@*Conclusions@#The pre-expanded propeller flap based on the supratrochlear artery or the supraorbital artery is an alternative option to repair the facial defect in appropriate cases.
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Objective@#To explore the clinical effect by using expander implantation immediately to repair the Medpor exposure after ear reconstruction.@*Methods@#From May 2013 to February 2017, 5 patients were treated with ear reconstructive surgery by Medpor implantation. The previous methods contained not only the auricular posterior fascia flap but also skin grafting. Exposed parts were the upper part of the helix and the wounds were dry without purulent secretions. Bacterial culture did not show bacterial growth. Surgical procedure was to remove the Medpor implant and implant a 50 ml kidney expander. When the wound was healed, we started to inject normal saline into the expander. About 3 months later the total volume of normal saline in the expanders were 80-100 ml.Then we could begin the second operation. We removed the expander and harvested the right side of the 7th and 8th rib cartilage, which were carved into the ear cartilage framework and transplanted into the expansion area. The drainage tube, negative pressure and cotton pad appropriate pressure bandage were needed. 6 days later we removed drainage tube.10 days later we removed the suture.@*Results@#The reconstructed external ear shape in five cases were good. No infection occurred. With 6-20 months of follow-up using telephone and WeChat, no obvious deformation of the shape or cartilage exposure occurred. The five patients did not come back to do the third stage operation for financial considerations. They all left their hometown to work out to reduce economic pressure.@*Conclusions@#In the case of ear reconstruction for Medpor prosthesis exposure, if the wounds were not infected, removing the Medpor and transplanting an expander at the same operative stage can achieve a good therapeutic effect.
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Objective@#To explore the anatomy of expended facial artery perforator flaps with cervical small perforators and its clinical application for extensive facial defects with this flap.@*Methods@#Necks of fresh cadavers were dissected for studying the anatomy basis of expended facial artery perforator flaps with cervical small perforators. Based on the anatomy, two-stage operation was performed. In the first stage, expander was embedded above the platysma and the pedicle, cervical small facial artery perforator was reserved. In the second stage, the expended perforator flap was transferred as propeller flap, advanced flap or tunnel flap to reconstruct extensive facial defects.@*Results@#Cadavers dissection revealed 3 or 4 perforators were derived from facial artery when it crossed marginal mandibular and vertically penetrated platysma to the superficial fascia layer to supply cervical skin. In clinic, all flaps presented with satisfactory functional and aesthetic outcomes.@*Conclusions@#This design of expended facial artery perforator flaps with cervical small perforators provide an excellent method for reconstruction of extensive facial defects.
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Objective@#To summarize clinical experience on reconstruction of severe facial disfigurement with flap prefabrication and soft tissue expansion.@*Methods@#From September 2005 to June 2016, 49 patients with type Ⅲ and type Ⅳ facial deformities underwent facial reconstruction with an integrated method on the basis of prefabricated flaps. In the first stage, the descending branch of the lateral femoral circumflex vessels and the surrounding muscle fascia were dissected and transferred to subcutaneous pocket in the cervicothoracic area. The pedicles of the fascial flap were anastomosed to either the facial or superior thyroid artery and their venae comitantes in flap prefabrication. A tissue expander was placed beneath the fascial flap. In the second stage, over-expansion was achieved with intra-flap stem cell transplantation once patient′s skin showed signs of intolerance to expansion. In the third stage, prefabricated flap was transferred to cover the facial defects. the second or third internal mammary artery perforators or lateral thoracic artery perforators were reserved and flap supercharging would be performed depending on the perfusion of the flap revealed by indocyanine green angiography intra-operatively. Later, flap revisions further restored facial outline and delicate organ configuration. Aesthetic and functional status were independently graded to assess the facial appearance and function before and after the reconstruction.@*Results@#49 patients with severe facial deformities were included. 5 patients received stem cell transplantation. The final inflated volume ranged from 2 530 ml to 3500 ml and each patient had facial reconstruction with a prefabricated flap (range 23 cm×18 cm-34 cm×32 cm). Flap supercharging technique were used in 25 cases to augment blood perfusion, however, flap necrosis (5 cm× 2 cm) occurred in 1 patient, and tip necrosis occurred in 4 patients, otherwise, all flaps survived entirely. The aesthetic (1.15 to 2.29) and functional (0.86 to 2.42) status scores were statistically improved (P<0.01). Facial expressions such as smiling, blinking and frowning were noted.@*Conclusions@#Autologous full face reconstruction with an integrated method based on flap prefabrication can bring satisfying aesthetic and functional recovery, rendering a safe and effective option for most patients with massive facial defects.
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Objective@#To explore the blood supply of expanded lateral neck flap combined with posterior auricular flap pedicled on anterior neck and the feasibility of this kind of flap for facial vulnus′resurfacing.@*Methods@#At the first stage of the treatment, one rectangular expander was implanted in lateral neck in the subcutaneous pockets, overlying the platysma, the volume of the expander is about 200-600 ml. After 2-3 months inflation, the pre-expanded lateral neck flap combined with posterior auricular flap was advanced at the second stage of the operation, the flap was rotated to lateral face to resurface the vulnus defects located on anterior auricle.@*Results@#Twelve cases of facial wounds were included in this research from January 2009 to November 2016. The size of the expanded flaps were ranged from 6 cm×12 cm to 7 cm×15 cm. According to 2 to 24 months follow-up postoperatively, 10 months in average, two flaps showed venous retardation at distal part of expanded flaps, which were recorvered with one-week dress changing after excoriation. The other ten flaps survived with good appearance and function. The flaps matched well to the recipient defects in terms of color, character and elasticity. The appearance and function of face and neck were ideally adjusted after treatment.@*Conclusions@#By expanding lateral neck skin overlying platysma, the expanded lateral neck flap combined with posterior auricular flap pedicled on anterior neck was obtained with high quality and maximum use of blood supply in the anterior neck, which guaranteed appearance and function of the donor area and the recipient area at the same time.
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Objective@#To investigate the method of repairing facial and neck defects.@*Methods@#From Sept. 2012 to June 2015, 18 cases of facial and neck scars were first implanted with 400-800 ml rectangular expanderin the thoracic triangle region; after 2-5 months expansion, liquidvolumereached 400-1 000 ml.After resection of facial and neck scar, defects were covered by the expanded deltopectoral thin flap; 7-10 days afterwards, flap pedicles were severed to cover the residual wound.@*Results@#A total of 19 expanders were implanted. All flaps survived after flap transfer and pedicle severance. The flap color and texture were close to the normal site.The skin was well recovered. After 2 years to 3 years follow up, all the affected areas achieved good outcome.@*Conclusions@#Ultra thin expanded deltopectoral flap is a good method for facial and neck defects reconstruction.
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Severe defects and deformities of face and neck normally arise from burns, tumor extirpation and trauma. They had long been a major therapeutic challenge in the realm of plastic and reconstructive surgery on account of massive involvement of skin and soft tissues, combined composite tissue injuries, high demands on aesthetic and functional outcomes, and scarce suitable reconstructive materials. After an extensive review of literature published recently, this article delineated up-to-date developments in autologous reconstruction and face allotransplantation, especially their indications and limitations in treating these patients. Meanwhile, an outlook on opportunities and challenges of these two treatment modalities was given.
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Severe defects and deformities of face and neck normally arise from burns, tumor extirpation and trauma. They had long been a major therapeutic challenge in the realm of plastic and reconstructive surgery on account of massive involvement of skin and soft tissues, combined composite tissue injuries, high demands on aesthetic and functional outcomes, and scarce suitable reconstructive materials. After an extensive review of literature published recently, this article delineated up-to-date developments in autologous reconstruction and face allotransplantation, especially their indications and limitations in treating these patients. Meanwhile, an outlook on opportunities and challenges of these two treatment modalities was given.