Objective To investigate the operative method and efficacy of subcutaneous pedicle scar-band rotation flap in the treatment of cervical postburn scar contracture. Methods Between August 2008 and May 2010, 15 patients with cervical postburn scar contracture were treated with subcutaneous pedicle scar-band rotation flaps, including 9 males and 6 females with an average age of 17.3 years (range, 7-35 years). The disease duration was 1-8 years (mean, 3 years). The locations were the left cervical region in 6 cases, the right cervical region in 8 cases, and mental cervical angle region in 1 case. According to LI Ao’s classification standard for cicartrical contracture, there were 12 cases of grade I and 3 cases of grade II. The area of scar ranged from 8 cm × 5 cm to 25 cm × 12 cm. After scar relaxation, wounds were repaired with the subcutaneous pedicle scar-band rotation flaps of 7 cm × 5 cm to 15 cm × 10 cm at size. In 3 cases of grade II, free split thickness skin grafts (7 cm × 4 cm to 12 cm × 7 cm at size) were used simultaneously. Results After 2 weeks of operation, 2 scar-band flaps had distal partial necrosis and healing was achieved after dressing change with formation of hypertrophic scar; the others survived with healing of incisions by first intention. After 6-12 months of follow-up, all patients possessed good cervical contours, sufficient release of scar contractures, and normal cervico-mandicular or mental cervical angles. The skin’s color and texture were satisfactory. There was no recurrence of cervical scar contracture and other complications. All patients acquired normal cervical movement at last follow-up. Conclusion Subcutaneous pedicle scar-band rotation flap is a simple, efficient, and versatile technique in release of cervical postburn scar contracture. It is an effective method to make use of the lateral excess scar flap to resurface defects caused by scar release.
Objective To introduce the experience of the cl inical appl ication of vertical trapezius myocutaneous flap in repairing soft tissue defects after head and neck tumor resection. Methods Between June 2008 and February 2010, 12 cases of soft tissue defect caused by head and neck tumor resection were repaired with vertical trapezius myocutaneous flap.There were 9 males and 3 females with an age range from 32 to 76 years (median, 54 years). Twelve cases including 2 cases of basal cell carcinoma of orbital skin, 2 cases of squamous cell carcinoma of the parotid gland, 2 cases of submandibular gland mal ignant mixed tumor, 2 cases of metastatic lymph nodes of nasopharyngea carcinoma after radiotherapy, 1 case of squamous cell carcinoma of tongue, and 3 cases of squamous cell carcinoma of occipital skin, and all were classified as TNM stages T3 or T4. The area of soft tissue defect ranged from 13 cm × 6 cm to 25 cm × 13 cm. The vertical trapezius myocutaneous flap ranged from 14 cm × 7 cm to 26 cm × 14 cm and was transfered to repair defect tissue in the homolateral wounds after tumor resection and neck dissection homochronously. The donor sites were sutured directly. Results All incisions healed primarily without infection. Eleven flaps survived except 1 flap with edge necrosis, which was cured after dressing change. Subcutaneous hematocele and effusion occurred in 2 cases on the back after tube was removed at 7 days postoperatively, and they were cured by sucted and pressured dressing. Eleven patients were followed up 1-3 years (mean, 2 years). Nine cases had no tumor recurrence and the flaps had statisfactory appearance; the abduction function of shoulder joint were normal. One case of orbit basal cell carcinoma occurred 3 months after operation and 1 case of nasopharyngeal carcinoma died of brain metastasis 12 months after operation. Conclusion It is an easy and simple therapy to repair head and neck soft tissue defect using the vertical trapezius myocutaneous flap, which can meet the needs of repairing tissue defect of head and neck.
【Abstract】 Objective To investigate the blood supply of the expanded skin flap from the medial upper arm andits appl ication for the repair of facial and cervical scar. Methods From May 2000 to February 2007, 20 cases (12 males and 8 females; aging from 7 to 42 years) of facial and cervical scar were treated with the expender flap from medial upper arm. The disease course was 9 months to 20 years. The size of the scar was 8 cm × 6 cm - 22 cm × 18 cm. The operation was carried out for three steps: ① The expander was embed under the superior proper fascia. ② The scar in the face and cervix was loosed and dissected. Combined the expanded skin flap from the medial upper arm(the size of the flap was 9 cm × 7 cm - 24 cm × 18 cm) in which the blood supply to the flap was the superior collateral artery and the attributive branches of the basil ica with auxil iary veins for blood collection with partial scar flap (3.5 cm × 2.5 cm - 8.0 cm × 6.0 cm) was harvested and transferred onto the facial and cervical defect. ③ After being cut off the pedicle, the scar was dissected. The expanded flap was employed to coverthe defect. Results After 3-24 months follow-up with 16 cases, all the grafted skin flaps survived at least with nearly normal skin color, texture and contour. The scars at the donor sites were acceptable. The function and appearance of the face and cervix was improved significantly. No surgery-related significant compl ications were observed. Conclusion Repair of facial and cervical scar with the medial upper arm expanded skin flap is a plausible reconstructive option for head and face reconstructions. However, a longer surgery time and some restrictive motion of the harvested upper l imbs might be a disadvantage.
Objective To choose suitable free flaps for reconstructing headand neck defects caused by tumor resection. Methods A retrospective analyses was made in 86 cases of head and neck defects treated with four kinds of free flaps between January 1999 and January 2002. The head and neck defects were caused by tumor resection. The locations were oral cavity (n=32), hypopharynx (n=27), mandible (n=12), skull base (n=5), scalp and skin (n=6) andmidface(n=4). The donor sites of free flaps included the rectus abdominis (n=32), anterolateral thigh (n=10),jejunum (n=25), fibula (n=11), latissimus dorsi (n=4), forearm (n=3) and scapula (n=1). The sizesof the cutaneous/musculocutaneous flaps ranged from 4 cm×5 cm to 14 cm×24 cm. The lengths of the fibula were 4-16 cm,of jejunum 9-20 cm. Results The overall free flap success rate was 92% (79/86). Of 32 oral cavity defects, 22 were reconstructed by rectus abdominis (69%) and 10 by anterolateral thigh flaps (31%). Of 27 hypopharyngeal defects, 25 were restored by jejunum flaps (93%). Eleven of 12 mandibular defects were reconstructed by fibula flaps(92%). Four of 5 defects of skull base were reconstructed by rectus abodominis flaps (80%). The free flaps of rectus abodominis, anterolateral thigh, jejunum and fibula were most frequently used, accounting for 91%(78/86) of all flaps in head and neck defect reconstruction. Conclusion Although head and neck defects represent a complicated spectrum of subsites and loss, these four freeflaps can manage most reconstruction problems.
Objective To discuss the reconstruction of severe neck contracture by transplanting combined scapular/parascapular bilobar flaps, and the probability to reestablish three-dimensional movement of the neck. Methods From January 2003 to November 2004, 9 cases of sustained severeneck contractures were treated (aged 9-32 years). The combined scapular/parascapular bilobar flaps, pedicled on the circumflex scapular vascular bundle, were microsurgically used to cover the soft tissue defect after excision of hypertrophic scar and release of contracture. The maximum size of the combined bilobar flap was 20 cm×8 cm to 20 cm×11 cm，while the minimum one was 15 cm×4 cm to 15 cm×6 cm. Results The combined scapular/parascapular flapswere successfully used to treat 9 cases of severe neck contracture. All patients were satisfied with the final functional and aesthetic results. There was no recurrence during 3-9 months follow-up for 8 patients. The cervicomental angle was 90-105°.Conclusion The combined bilobar scapular/parscapular flap, providing a large area of tissue for coverage in three dimensions with a reliable blood supply by only one pedicle anastomosis during operation, is agood option for reconstruction of the severe neck contracture.
Objective To evaluate the effect of a combined cervicalexpanded skin flap in repairing cervical scar contracture deformity after burn injury. Methods From April 2001 to May 2003, 16 cases （10 males and 6 females）of scar contracture deformity in the cervix were treated withexpanded clavipectoral axis skin flap combined with reverse axis skin flap．The tissue expanders were embedded under the part containing cutaneous branches of transverse cervical artery in cervical segments and the second and/or the third perforating branch of internal thoracic artery for the first operation. Normal saline was injected regularly. The expanded clavipectoral skin flap and reverse axis skin flap with perforating branch of internal thoracic artery were designed,the scar in the cevix was loosed or dissected according to the size of the skinflaps, the skin flaps were transferred to cover the wound, and the contracture deformity in the cervix was corrected. The size of the flaps were 9 cm×5 cm-15 cm×7 cm. Results All skin flap survived. The function and appearance of the cervix was improved significantly after 6-30 months follow-up. However, venous return dysfunction in reverse perforating branch of internal thoracic artery occurred in 1 case, andblood circulation was improved after treatment. Conclusion Expanded clavipectoral axis skin flap combined with reverse axis skin flap can be used to repair scar contracture deformity in cervix, which lessen scar and abatethe chance to contract again.