Region-Oriented and Staged Treatment Strategy in Reconstruction of Severe Cervical Contracture
Region-Oriented and Staged Treatment Strategy in Reconstruction of Severe Cervical Contracture
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重度颈椎挛缩重建的分区分期治疗策略
DOI：
10.1371/journal.pone.0122669
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发表时间：
2015-04-09
期刊：
影响因子：
3.7
通讯作者：
Levin, Lawrence Scott
中科院分区：
文献类型：
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作者：
Luo, Xusong;Liu, Fei;Levin, Lawrence Scott
烧伤后严重的颈部挛缩会导致颈部运动和外形美观明显受损。虽然已经描述了用于治疗的各种手术技术，但没有明确的策略来指导治疗。在过去的6年里，我们一直采用区域导向和阶段性治疗策略来指导严重颈椎挛缩的重建。已取得了令人满意的结果与此strategy.MethodsThe第一阶段的治疗重点放在颈前区和颏下区。手术包括瘢痕切除，挛缩松解，颈阔肌分离和提升形成两个颈阔肌瓣，以及皮肤移植。三至六个月后，进行第二阶段治疗，其定位于精神区域。包括疤痕切除、下唇外翻矫正、肩胛皮瓣游离重建。结果4例患者均完成了颈颏角重建术，术后随访1 ~ 12个月。术后3个月，CM角发生显著变化：软组织CM角从135.0度+/- 17.3度减小到111.1度+/- 11.3度，骨CM角从67.1度+/- 9.0度增加到90.5度+/- 11.6度，动态CM角从21.9度+/- 11.6度增加8.7度至67.4度+/- 13.1度。22在24例（91.7%），这些患者获得了显着改善颈部运动和美学controls.ConclusionsOur结果表明，区域导向和分期治疗策略可以达到满意的功能和美学效果，结合使用两种皮肤移植和皮瓣，同时尽量减少供区发病率。
IntroductionSevere cervical contracture after burns causes obvious impairment of neck movement and the aesthetic silhouette. Although various surgical techniques for treatment have been described, there is not a definitive strategy to guide treatment. Over the past 6 years, we have been utilizing a region-oriented and staged treatment strategy to guide reconstruction of severe cervical contracture. Satisfactory results have been achieved with this strategy.MethodsThe first stage of treatment focuses on the anterior cervical region and submental region. Procedures include cicatrix resection, contracture release, division and elevation of the platysma to form two platysma flaps, and skin grafting. Three to six months later, the second stage treatment is performed, which localize to the mental region. This includes scar resection, correction of the lower lip eversion, and reconstruction with free (para) scapular skin flap. Three subtypes of cervicomental angle that we proposed were measured as quantitative tool for evaluation of the reconstruction.Results4 patients who completed the treatment were reviewed. By the 3rd postoperative month, their CM angles changed significantly: the soft tissue CM angle was reduced from 135.0 degrees +/- 17.3 degrees to 111.1 degrees +/- 11.3 degrees, the osseous CM angle increased from 67.1 degrees +/- 9.0 degrees to 90.5 degrees +/- 11.6 degrees and the dynamic CM angle increased from 21.9 degrees +/- 8.7 degrees to 67.4 degrees +/- 13.1 degrees. 22 in 24 (91.7%) of these patients gained notable improvement of cervical motion and aesthetic contour.ConclusionsOur results suggest that the region-oriented and staged treatment strategy can achieve satisfactory functional and aesthetic results, combining usage of both skin graft and skin flap while minimizing the donor site morbidity.