Reconstruction of difficult wounds with tissue-expanded free flaps
Reconstruction of difficult wounds with tissue-expanded free flaps
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DOI：
10.1097/01.sap.0000122855.89739.55
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发表时间：
2004-05-01
影响因子：
1.5
通讯作者：
Newton, ED
中科院分区：
文献类型：
--
作者：
Acarturk, TO;Glaser, DP;Newton, ED
移植前游离皮瓣的组织扩张已被用于增加移植组织的大小，并允许供区的一期缝合。这在缺乏健康组织的烧伤和相对缺乏组织的儿童中尤其重要。在这项研究中，作者介绍了他们17年的经验，组织扩张游离皮瓣。1985年至2002年，作者所在单位共施行了14例游离皮瓣移植前组织扩张术。血管化组织的适应症为9例面部缺损（8例严重烧伤和1例神经纤维瘤病），3例脊柱裂导致的腰骶部大溃疡，1例因Chron病切除导致的外阴会阴部大缺损，1例因Turner摘除术导致的下肢周围大组织缺损。其中前臂桡侧皮瓣6例，肩胛旁皮瓣4例，臂外侧游离皮瓣4例。将组织扩张器放置在深筋膜和肌肉层之间的皮下平面下，保留椎弓根结构和完整性。组织扩张器的大小范围为250至700 mL，每周或每两周进行一次扩张，持续10至20周。随访1 ~ 17年。研究结果基于供体和受体部位发病率、并发症发生率、患者满意度以及供体和受体部位的长期结局。受体部位的任何转移组织均未失效，也未发生组织损失。3例患者出现游离皮瓣一过性充血，无需干预即可解决。所有患者的供区均一期缝合。1例黑人患者在前臂桡侧供区有增生性瘢痕形成，需要再次扩张和一期缝合。在其他患者中，疤痕是可以接受的。1例患者在组织扩张器部位发生感染，第二天取出植入物并将游离皮瓣转移到受体缺损处。在4例面部烧伤患者中，接受部位的游离皮瓣在移植后进行了组织扩张，以便在以后进行小的翻修。所有患者均获得了良好的结局，并对手术感到满意。游离皮瓣预扩张是一种有效的方法，但未得到充分利用。它在并发症方面是安全的，导致供体部位瘢痕更好地显现，并且允许在组织缺损的患者中转移更大量的组织。
Tissue expansion of free flaps before transfer have been used to increase the size of the transferred tissue and to allow primary closure of the donor site. This is especially important in burns when there is a lack of healthy tissue, and in children when there is a relative lack of tissue. In this Study the authors present their 17-year experience with tissue-expanded free flaps. Between 1985 and 2002, 14 cases of tissue expansion of free flaps before transfer were performed at the authors' institution. The indications for vascularized tissue were 9 facial defects (8 severe burns and I neurofibromatosis), 3 large lumbosacral ulcers resulting from spina bifida, I large vulvoperineal defect resulting from resection for Chron disease, and I large circumferential tissue defect at the lower extremity resulting from turner extirpation. The flaps were 6 radial forearm, 4 parascapular, and 4 lateral arm free flaps. Tissue expanders were placed under the Subcutaneous plane between the deep fascia and the Muscle layer, preserving the pedicle architecture and integrity. The size of the tissue expander ranged front 250 to 700 mL and expansions were done either weekly or biweekly for a 10- to 20-week period. The patients were followed for I to 17 years. The outcome of the study was based on donor and recipient site morbidity, rate of complications, patient satisfaction, and long-term outcome of the donor and recipient sites. There was no failure in any of the transferred tissue at the recipient site and no tissue loss. Three patients had transient congestion of the free flaps, which resolved without an intervention. In all patients the donor area was closed primarily. One black patient had hypertrophic scar formation at the radial forearm donor site requiring reexpansion and primary Closure. In other patients the scar was acceptable. One patient had all infection at the tissue expander site that was treated with removal of the implant and transfer of the free flap to the recipient defect the following day. In 4 patients with facial burns, posttransfer tissue expansion of the free flap at the recipient site was performed for minor revisions at later dates. All patients had good outcomes and were satisfied with the procedure. Preexpansion of free flaps is an effective but underused method. It is safe in terms of complications, results in a better appearing donor site scar, and allows transfer of larger amounts Of tissue in patients with tissue deficiency.