【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 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.
Since 1987, One hundred and fifty-four patients suffered from alopecia, neck and facial scar, and nasal defect had been treated with skin soft tissue expansion. The incidence of complication was decreased markedly, compared to previons report which was 11.7%. Two cases of this group were given up this procedure. The lessous learned from these case were as following. Strictly evaluated the case according to the indication, examined the expander carefully, improved the techniques to inbed the expander and infilled the sailine, those of which could obtain satisfactory result.
Abstract In order to investigate the pattern of the changes of blood supply of the vascular superthin skin flap during expansion, in 17 patients, under the subdermal vessel networks layer of the periauriclar area, an expander was placed, and the skin was preliminarily expanded. The changes of blood supply were found regular: When the injected fluid volume was excessive, the skin became pale or cyanotic, the skin showed congestive telangiectasis. If great care was given during the procedure, the expanded skin could pass safely through the stage of poor blood circulation. The expanded superthin skin flap were applied in auriculoplasty in 17 patients. The results included 3 failures, and 14 satisfactory.