Methods and clinical effects of reconstructing facial and cervical scars with expanded flaps based on the"MLT"principle
Objective To explore the methods and clinical effects of reconstructing facial and cervical scars with expanded flaps based on the"MLT"principle.Methods The study was a retrospective observational study.From January 2019 to May 2022,74 patients with facial and cervical scars after burn or trauma injuries who met the inclusion criteria were admitted to Xiangya Hospital of Central South University,including 38 males and 36 females,aged from 5 to 58 years,including 24 patients with simple facial involvement,24 patients with simple cervical involvement,and 26 patients with both facial and cervical involvement,with scar area ranging from 12 to 145 cm2.By following the"MLT"principle(color and texture similar to the face;flap area large enough to reconstruct the entire defect;skin tissue thin enough to transmit the expression,so as to facilitate the shape of the face and five features);in the stage Ⅰ surgery,the skin and soft tissue expanders(hereinafter referred to as the expanders)were implanted,and in the stage Ⅱ surgery,the expander removal+scar resection+flap transplantation to repair the secondary wound was performed,and the wound in the donor area of flap was directly sutured.After operation,silicone gel preparation and laser therapy were used to prevent scar hyperplasia.The expansion ratio and time period of expanders,the occurrence of complications of skin and soft tissue expansion surgery,the type of flap used,and the survival of flap after the stage Ⅱ surgery were observed and recorded.The long-term effect of facial and cervical reconstruction and the recovery of donor area and recipient area of flap were evaluated during the postoperative follow-up after surgery.Results The expansion ratio of 135 expanders ranged from 1.36 to 3.00 times,and the expansion time period ranged from 6 to 14 months.During skin and soft tissue expansion surgery,8 patients had poor healing of incisions after expander placement,7 patients had expander rupture,5 patients had infection in incisions after expander placement,3 patients had expander exposure,2 patients had difficult filling the injection pot,and 1 patient had water leakage from the injection pot.Dorsal shoulder expanded flaps with double blood supply of transverse cervical artery and circumflex scapular artery were used in 8 patients,the expanded flaps of anterior transverse carotid artery perforator were used in 11 patients,the expanded flaps of internal thoracic artery perforator were used in 12 patients,tandem expanded flaps of upper chest and neck were used in 16 patients,dorsal thoracic artery perforator expanded flaps were used in 5 patients,and adjacent rotary propulsive expanded flaps were used in 22 patients.After the stage Ⅱ surgery,the flaps of 71 patients were completely survived.One patient had blood circulation disorder in the flap,and the flap survived after hyperbaric oxygen treatment.Necrosis occurred at the end of the flaps in 2 patients,which healed after dressing change.After the surgery,42 patients were followed up for 3 to 24 months.The color,texture,and thickness of flaps were good and similar to the surrounding normal skin tissue in the recipient area,the appearance and function of the face and neck were significantly improved,and the wound location in the donor and recipient areas of flaps was concealed with slight scar formation.Conclusions In the reconstruction of facial and neck scars,by following the"MLT"principle,the expanded flap was carefully designed before surgery,the local aesthetic features within the subunit are reconstructed during the stage Ⅱ surgery,and standard anti-scar treatment measures are actively adopted after surgery.After reconstruction,the color,texture,and thickness of flaps were close to the normal skin in face and neck,and the appearance and function of face and neck are significantly improved,with less linear scars left.It is beneficial to improve the therapeutic effect.
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