应用真皮下血管网皮片修复面部皮肤软组织缺损(1)
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[摘要]目的：介绍应用真皮下血管网皮片修复面部皮肤软组织缺损的效果。方法：根据面部皮肤软组织缺损创面的大小，设计相同大小的真皮下血管网皮片，将皮片用于创面修复。结果：术后皮片全部成活，均获得了良好的外形和功能恢复，未出现感染、血肿及皮片坏死等并发症，一次手术完成治疗。所有患者随访6月～2年，修复皮片与周围皮肤组织在色泽、质地匹配，面部的轮廓形态及视觉效果良好，效果均满意。结论：应用真皮下血管网皮片修复面部皮肤软组织缺损，保持皮肤色泽、质地一致性，效果可靠，是获得良好的面部形态和功能效果的一种修复方法。
[关键词]真皮下血管网皮片；面部；皮肤软组织缺损
[中图分类号]R622[文献标识码]A[文章编号]1008-6455(2011)05-0726-02
Using the subdermal vascular plexus free skin graft to repair the skin and soft tissue defects
LI Bo-tao,AN Ke-ren, LI Ping,YANG Yu-zi,LIU Xiao-wei,PANG Jian-hua
(Department of Plastic and Aesthetic, The Fifth Hospital of Harbin City, Harbin 150040, Heilongjiang, China)
Abstract:ObjectiveTo investigate the effect of using the subdermal vascular plexus free skin graft to repair the skin and soft tissue defects.MethodsAccording to the size of the facial skin and soft tissue defect,design a subdermal vascular network flap which size is same to the defect and use it to repair the defect.ResultsPostoperative,all the skin grafts survived and received good outline and function,no infection, hematoma formation, and complications such as skin necrosis. An operation completed treatment.All patients were followed up for 6 months to 2 years.The repaired skin is a match for the surrounding skin in color and texture.The facial contour and visual effects are good, effects are satisfactory.ConclusionThe application of subdermal vascular network flap repairing facial skin and soft tissue defects can keep consistency in skin colour and texture.It is reliable.It is also a method to obtain a good facial morphology and function.
Key words: subdermal vascular plexus free skin graft；fcial；skin and soft tissue defect
颜面部因色素痣、体表肿瘤及瘢痕等各种原因手术切除后，引起皮肤软组织继发性缺损，整形外科医师常采用局部皮瓣修复皮肤软组织缺损。当缺损太大，难以直接缝合时，采用传统的全厚皮片和中厚皮片移植修复缺损，往往因为术后存在着皮片收缩，色素沉着明显，耐磨性能差，面部表情呆板，色泽不协调等，患者对外形不满意。由此自2007年以来，我院对面部因色素痣、瘢痕、肿瘤等手术后引起的继发性皮肤软组织缺损患者应用带真皮下血管网皮片修复,术后获得了满意的效果，现报道如下。
1临床资料
本组57例，男36例，女21例，年龄5～46岁，平均24.7岁。皮肤缺损由瘢痕切除所致者41例，色素痣切除所致者14例，血管瘤切除所致者2例。应用真皮下血管网皮片修复最小面积5cm×3.5cm，最大14cm×9cm。
2手术方法
所有患者术前检查血常规和出凝血时间功能均正常，术前清洁局部皮肤。在全身麻醉下或局部浸润麻醉下将面部的色素痣、瘢痕等病灶完全切除，供皮区选在上臂内侧、股内侧或侧胸腹部尽可能隐蔽部位，依据切除后皮肤软组织缺损范围大小，选择设计相应大小皮片，取皮后供区伤口直接拉拢缝合，将取下皮片用组织剪刀修剪为带真皮下血管网皮片，覆盖缺损区以修复创面，术后5-0丝线打包加压包扎，术后预防性使用抗生素3～5天，10天拆线。
3结果
所有移植皮片全部成活，术后移植区肤色外观正常，不臃肿 ......
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