【Abstract】 Objective To investigate the method and effectiveness of expanded delto-pectoral and abdominalperforator flaps in repairing large defects of the face and upper limb after scar excision. Methods Between August 2000 and February 2011, 25 patients with large scars on face and upper l imb were treated. There were 14 males and 11 females with an average ageof 27 years (range, 7-36 years). Scars causes were burn and scald in 25 cases with a disease duration of 6 months to 7 years (mean, 4.5 years). The hypertrophic scars located at face in 15 cases, and at upper limb and hand in 10 cases. The soft tissue expanders (300-500 mL in volume) were implanted in the delto-pectoral zone and abdominal region in one-stage operation. In two-stage operation, after scars were resected, defects (9 cm × 7 cm to 17 cm × 8 cm) were repaired with the delto-pectoralperforator flaps (17 cm × 7 cm to 20 cm × 8 cm) in 15 facial scar cases and with the deep inferior epigastric artery perforator flaps (10 cm × 9 cm to 25 cm × 14 cm) in 10 upper limb and hand scar cases. The donor sites were sutured directly. Results Partial necrosis of the flaps occurred in 2 cases after operation, then the flap survived after expectant treatment. The other flaps and skin grafts survived successfully, and the incisions healed by first intention. Ten patients were followed up 6 months to 4 years. Theappearance, texture, and color of the flaps were similar to those at the donor site. Conclusion It is an effective method to use the delto-pectoral perforator flap and the deep inferior epigastric artery perforator flap for repairing soft tissue defects of the face and upper limb after scar excision.
Objective To investigate the application of the fibrous envelope of tissue expanders for the tension reduction. Methods Between June 2005 and May 2011, 21 patients with facial scar were treated with skin soft tissue expansion. There were 6 males and 15 females, aged 19-33 years (mean, 24.5 years), including 19 cases of hypertrophic scar and 2 cases of atrophic scar with disease duration of 1-31 years. The scars ranged from 4 cm × 2 cm to 25 cm × 10 cm. The tissue expander was implanted under normal skin adjacent to lesions in the first stage. And the post-expanded skin flap was designed as advance flap or transpositional flap as supplement in the second stage. Fibrous envelope at the base was fixed to the periosteum or fascia nearby first, and then sutures were used between envelopes at the base and on the skin flap or to the dermis of the skin flap to keep the mouth and lower eyelid in proper position. It reduced the tension of incision and maintained the contour of the face and neck. Results After the first stage operation, 2 cases had replaced expanders because of infection and leakage. No complication of infection or hematoma occurred after the second stage operation. The patients were followed up 1-18 months (mean, 10.2 months); of them,12 were followed up more than 1 year. No secondary deformity (deviation of mouth angle, eyebrows pulling, or eyelid ectropion) occurred. The flaps had good appearance and color. The satisfactory results were achieved. Conclusion In skin soft tissue expansion of the face, the fibrous envelopes at the base could reduce the tension of the incision and prevent the deformity of the mouth and lower eyelids.
Objective To explore the feasibility of applying poroushigh density polyethylene (Medpor) as framework for auricle reconstruction of congenital oracquired auricular defects. Methods From February 1999 to February 2004, 61 patients suffering from congenital or acquired auricular defects underwent auricle reconstruction with Medpor framework after expanding postauricular skin. Among them, there were 38 males and 23 females, aging from 5 to 61 years. In 40 cases of congenital microtia, two sides were involved in 1 case and one side in 39 cases. In21 cases of traumatic auricle damage, two sides were involved in 6 cases and one side in 15 cases. The operation was performed by two stages. First stage:the expander was implanted underneath postauricular skin or soft tissuesuch as notrophic scar tissue for the traumatic auricle defect. Second stage:the expander was removed and auricle reconstruction was performed by placing Medpor framework between the expanded skin/scar flap and the underlying fascial flap. Results Sixty-one patients obtained successfully reconstructed auricles. During a followup of 6 months to 5 years and 1 month (mean 2.8 years), the results were excellent and good in 49 cases (80.3%) , fair in 7 cases (11.5%) and poor in 3 cases (4.9%)，2 cases (3.3%) underwent replacement of Medpor framework with autogenous costal cartilage after 6 months of operation. Conclusion Medpor framework would be applied safely, simply and reliably in condition that auricular framework is unfit or reluctant to undergo auricle reconstruction by using autogenous costal cartilage.
Objective To summarize the prevention and treatment of postoperative complications after the skin soft tissue expansion for scar alopecia. Methods From January 1995 to June 2005, 57 patients with scar alopecia were admitted to our department for treatment. Of the patients, 25 were males and 32 were females with their ages ranging from 5 to 55 years. The causes were burn in 33 patients, trauma in 14, alopecia after head surgery in 8, and other causes in 2. Their disease courses ranged from 6 months to 15 years. Fortreatment, 89 therapeutic expanders were utilized in 57 patients. The retrospective analysis on the complications and their prevention and treatment were performed. Results The follow-up for 3-12 months averaged 6 monthsrevealed that 81 areas undergoing the expander insertion healed well and the hair grew well, too. Eight areas undergoing the expander insertions had complications, including expander exposure in 2 patients, infection in 2, hematoma in 1, expander rupture in 1, necrosis of the flap tip in 1, and scar necrosis at the injection port in 1. The results also revealed that there was a significantly increased rate of complications in the patients aged 5-10 years and the patients older than 50 years （Plt;0.05）. The complication rate in the patients who received 2 expanders at one time was significantly higher than that in the patients whoreceived only 1 expander（Plt;0.05）. However, there was no significant difference in the complication rate in the other kinds of patients. All the complicationswere effectively treated with a satisfactory therapeutic result. Conclusion The skin soft tissue expansion for scar alopecia can effectively prevent and treat postoperative complications. If the complications are identified early and treated properly, the therapeutic results will be satisfactory.
Objective To evaluate a new reconstruction method for grades Ⅴ and Ⅵ defect with flap by skin soft tissue expansion technique. Methods From May 1998to September 2003, 8 cases of serious thumb defect were treated, including 6 males and 2 females, aging 18-27 years. The defect was caused by crush injury ofmachine in 6 cases and hot crush injury in 2 cases( 5 cases of grade Ⅴ and 3 cases of grade Ⅵ). The expander was placed under the tenor skin and softtissue.And then normal saline was infused to expand the skin and soft tissue graduallytill it was available for thumb reconstruction. Iliac autograft was fixed to residual thumb stump and covered with flap produce by expanded skin and soft-tissue.Postoperative rehabilitation was carried out. Results Allreconstructed thumbs were alive. After3-24 months follow-up, all reconstructed thumbs were with good sensation, appearance and durable. Twopoint discrimination was less than 5 mm. The functions of opposition, extend, abduction and endoduction were better in grade Ⅴ thumb defect than in grade Ⅵ thumb defect. Bone union was achieved within 3 to 4 months. Conclusion It is a convenient-to-operate and reliablemethod for thumb reconstruction. It is an alternative new reconstruction methodfor grades Ⅴ and Ⅵ thumb defect.
Objective To investigate the clinical application of skin soft-tissue expansion in repairing large-cicatricial alopecia. Methods From January 1989 to December 2003, 38 cases of large cicatricial alopecia were repaired by expanding scalp. The scalp was expanded, the cicatrix area was resected and the mode of propulsive or rotary flap was adopted. The size of alopecia ranged from 15 cm×7 cm to 23 cm×15 cm. Results The cicatricial alopecia in all the 38 cases was repaired and the hair growth was excellent during 1.2 year follow-up. Conclusion The soft tissue expansion technique is the initiative choice and an efficient method for repairing large cicatricial alopecia.
OBJECTIVE To introduce the clinical application of the expanded graft from scalp in the repair of cicatricial baldness in children. METHODS 45 cases with baldness following burn from 1988 to 1998 were reported. All of these patients (age ranged from 5-11 years) were treated by soft tissue expander. RESULTS 5 cases were followed up for 1-2 years, the clinical results showed that the result from the graft of scalp expansion was satisfactory, and the long-term follow-up revealed that the hair in expended area and that in normal area was almost the same except the orientation of hair distribution had some difference. CONCLUSION The head scalp expansion might be the first choice in the repair of cicatricial baldness following burn.