OBJECTIVE: To evaluate the clinical efficacy of fasciocutaneous flap in the repair of the III degree burn wound in the facio-cervical region. METHODS: From January 1997 to October 2001, 11 cases of III degree burn wounds in the facio-cervical region were repaired with the cervical-thoracic fasciocutaneous flap ranging from 18 cm x 8 cm to 13 cm x 5 cm. Donor sites were covered with "Z" plasty or skin grafting. RESULTS: Except for partial necrosis of distal end of the flap in 1 case, the flaps in the other 10 cases all survived and presented satisfactory appearance and function during the following up. CONCLUSION: The fasciocutaneous flap in the cervical-thoracic region may provide a large area of flap, and can be easily transferred. It’s an ideal flap for the repair of skin defect in the facio-cervical region, especially for the repair of the wounds with infection or exposure of vessel, nerve and tendon.
In order to study the clinical efficacy of bilateral cervico-thoracic skin flap on repairing the contracture of the burn scar of the neck, 66 flaps were used in 33 patients from 1983 to 1995. The size of the flap ranged from 5 cm x 6 cm to 8.5 cm x 15 cm. The donor site was covered with split skin graft. The ratio between the length and the width of the flaps should not exceed 3:1. Fifty-nine flaps survived completely, but 7 had necrosis of small area which was healed without any influence on the function and appearance. The operative technique of the bilateral cervico-thoracic skin flaps were reported. The advantages of this type of skin flap and its applied anatomy and the postoperative care were discussed. In the repair of the cicatritial contracture deformity of the neck, it was important to define whether the skin defect was located in the submandibular, anterior cervical or anterior thoracic region, thus appropriate type of repair could then be given accordingly.
OBJECTIVE To evaluate the efficacy of musculocutaneous flap containing the upper part of bilateral trapezius muscles in the treatment of cicatricial contracture deformity of neck. METHODS From January 1990 to January 1997, twelve cases were treated by musculocutaneous flap containing upper part of bilateral trapezius muscles from 14 cm x 16 cm to 28 cm x 11 cm in size, and 9 of the 12 cases were followed up for 2-3 years. RESULTS Primary healing of the wounds was observed in all of the cases. The function and the external appearance were satisfactory, and no graft contracture was found in the 9 cases followed up. CONCLUSION The musculocutaneous flap grafting was an ideal method in the repair of soft tissue defect of neck, with the advantage of invariable blood supply and simple operative procedure.
OBJECTIVE: To sum up transplantation of free scapular flap to repairing injury of faciocervical region, 103 cases in past 16 years were reviewed. METHODS: The scapular flap contained the ascending, descending, and transverse branches of the circumflex scapular artery. The range of the flap was as following: across the scapular spine to the acromion in upper edge, to the level of anterior iliac spine in lower edge, to the bilateral middle axillary line in both sides. RESULTS: The clinical result was good. Fifty eight cases were followed up for 3 months to 10 years, the function of the faciocervical region was recovered with satisfied contour. In part of the patients, a second-stage operation was performed to make the flap thinner. CONCLUSION: The maximal range of the flap can be 45 cm x 16 cm. For its sufficient blood supply, it should be of no influence on survival of the flap if the window is open in suitable site. Because of its large range of donating region and sufficient blood supply, it is fit for children.
OBJECTIVE To repair facial and neck scar using tissue expanding technique. METHODS From January 1991 to January 1995, 16 cases with facial and neck scar were treated. Multiple tissue expanders were put under the normal skin of facial and neck area, after being fully expanded, the scars were excised and the expended skin flaps were transplanted to cover the defects. The size and number of tissue expanders were dependent on the location of the scars. Normally, 5 to 6 ml expanding volume was needed to repair 1 cm2 facial and neck defect. The incisions should be chosen along the cleavage lines or in the inconspicuous area, such as the nasolabial fold or submandibular region. The design of flap was different in the face and in the neck. In the face, direct advanced flap was most common used, whereas in the neck, transposition flap was often used. Appropriate tension was needed to achieve smooth and cosmetic effect. It was compared the advantages and disadvantages of several methods for repair of the defect after facial and neck scar excision. RESULTS Fifteen cases had no secondary deformity after scar excision. Among them, 1 case showed blood circulation disturbance and cured through dressing change. Ten cases were followed up and showed better color and texture in the flap, and satisfactory appearances. CONCLUSION Tissue expanding technique is the best method for the repair of facial and neck scar, whenever there is enough expandable normal skin.
Objective To simplify surgical technique andincrease postoperative survival rate, sleeve anastomosis technique combined cuff technique was used in developing the model of cervical heart transplantation in rats. Methods In this model, the hearts from 25 male SD rats were transplanted into the neck of Wistar rats by anastomosing the donor innominate artery to the recipient right common carotid artery by use of sleeve technique, and the donor pulmonary artery to the recipient right external jugular vein by use of cuff technique. After operation,the rats were treated with cyclosporine A (1.5mg/kg, q.d.), transplanted hearts were followed by daily inspection or palpation and the allograft survival time was more than 3 days as the standard of successful operation. Results The mean operative time was (48.7±3.4) min, with a successful rate of 88%(22/25). Complications were anastomotic hemorrhage( 1 case) and thrombosis(2 cases). During the followup period, 6 rats died of pulmonary infection, abscess in the neck,liver or bladder tumor. The remaining 16 transplanted hearts survived more than3 months. Conclusion The modified operation have advantages ofless operative procedure, shorter operation and ischemia time and easier monitoring of graft function.
Objective To probe the principle and the method to repair facial soft tissue defect with the prefabricated expander flap the neck with the vessles of temporalis superficialis. Methods The expandor was implanted into the surface layer of the platysma in neck. The pedicle of the expander flap contained the arteria temporalis superficialis and its ramux parietalis. After 3 months, the prefabricated island expander flaps pedicled with the arteria temporalis superficialis and its ramux parietalis could be transferred to the face. From 1998 to 2003, 6 cases of facial soft tissue defects were repaired. The maximal flap size was 12 cm×8 cm.Thepedicel length was 7.8 cm.Results After a follow-up of 3-6 months, all expander flaps survived. The excellent function and cosmetic result were achieved. Conclusion The prefabricated expander flaps of the neck pedicled with the arteria temporalis superficialis and its ramux parietalis can be transferred to the upperface to repair tissues defect. The supply of blood of the prefabricated expander flaps were safe and reliable. The survived areas of the flaps are directly proportional to the areas of temporalis superficialis fascia combining the expander flaps.
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.
OBJECTIVE To evaluate the clinical efficacy of thin flap with subdermal vascular network of the neck-pectoral region on repair of the contracture of the burn scar on the neck. METHODS From March 1990 to May 1998, 21 cases of deformity of neck due to burn scar were repaired with the thin flap ranging from 8 cm x 5 cm to 14 cm x 8 cm, and all of the cases were followed up for 6 to 42 months. RESULTS Except partial necrosis of the distal end of the flap in 1 case, the flaps in the other 20 cases all survived and presented a satisfactory appearance and function. CONCLUSION The thin flap with subdermal vascular network in neck-pectoral region may provide a large area of flap, and could be easily transferred. It’s an ideal flap for the repair of skin defect on the neck.