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.
In order to correct the dysfunction of head and neck with scar contracture, since 1980, sixty-two cases were undertaken the operation by using local skin flap to repair the soft tissue defect after scar resection. The skin flaps included pedicled delto-thoracic skin flap in 26 cases, cervico-thoracic skin flaps in 25 cases, cervico-shoulder flaps in 6 cases, pedicled vascularized extralong delto-thoracic skin flap in 4 cases and free parascapular flap in 1 case. Sixty cases had total survival of the flaps and 2 flaps had partial necrosis. After 1 to 10 years follow-up, the appearance and function of neck were excellent. It was suggested that grafting local skin flap was a good method to treat cicatricial deformity of neck especially using the skin flap with pedicle and vascular bundle.
A combined rotational flap was used to repair large scar on the face. The flap was removed from the lateral part of the neck, face and postaural region, between the zygmatic arch and clavicle. The dissection was carried out on the superfic ial of SMAS and platysmus M. Twentysix (12 males and 14 females) were reported. The age ranged from 5 to 28 years. The flap was survived completely in 19 cases. Small area at the margin of the flap was necrotic, which was reducing appeared in the postaural cular region in 6 cases. By reducing the size of the postaural cual component of the flap, necrosis never occured. Among these cases, 11 were followed up for 6 to 14 months. The results were satisfactory. The combined flap was classified as randomized flap because it had no axial and it could be used to cover a large area of skin defect. The color, thickness and quality of the flaps were all close to the normal facial skin. It was considered especially suitable for repair the large wound on the medial twothirds of the cheek.
Objective To analyze the clinical characteristics of scar cancer ulcer wound of head and face, and to investigate its diagnosis and treatment. MethodsThe clinical data of 14 patients with head and facial scar cancer ulcer wounds who met the selection criteria and admitted between January 2021 and March 2022 were retrospectively analyzed. There were 8 males and 6 females. The age of onset ranged from 21 to 81 years with an average age of 61.6 years. The incubation period ranged from 1 month to 70 years, with a median of 4 years. Site of the disease included 7 cases of head, 6 cases of maxillofacial region, and 1 case of neck region. Injury factors included trauma in 5 cases, scratch in 5 cases, scalding in 2 cases, burn in 1 case, and needle puncture in 1 case. Pathological results showed squamous cell carcinoma in 9 cases, basal cell carcinoma in 3 cases, sebaceous adenocarcinoma in 1 case, papillary sweat duct cystadenoma combined with tubular apocrine sweat gland adenoma in 1 case. There was 1 case of simple extensive tumor resection, 1 case of extensive tumor resection and skin grafting repair, 7 cases of extensive tumor resection and local flap repair, and 5 cases of extensive tumor resection and free flap repair. ResultsAll the 14 patients were followed up 16-33 months (mean, 27.8 months). Two patients (14.29%) had scar cancer ulcer wound recurrence, of which 1 patient recurred at 2 years after 2 courses of postoperative chemotherapy, and was still alive after oral traditional Chinese medicine treatment. One patient relapsed at 1 year after operation and died after 2 courses of chemotherapy. One patient underwent extensive resection of the left eye and periocular tumor and the transfer and repair of the chimaeric muscle axial flap with the perforating branch of the descending branch of the left lateral circumflex femoral artery, but the incision healing was poor after operation, and healed well after anti-infection and debridement suture. The wounds of other patients with scar cancer ulcer did not recur, and the wounds healed well. ConclusionScar cancer ulcer wound of the head and face is common in the middle-aged and elderly male, and the main pathological type is squamous cell carcinoma. Local extensive resection, skin grafting, or flap transfer repair are the main treatment methods. Early active treatment of wounds after various injuries to avoid scar repeated rupture and infection is the foundamental prevention of scar cancer.
ObjectiveTo evaluate the effectiveness of different flaps for repair of severe palm scar contracture deformity. MethodsBetween February 2013 and March 2015, thirteen cases of severe palm scar contracture deformity were included in the retrospective review. There were 10 males and 3 females, aged from 14 to 54 years (mean, 39 years). The causes included burn in 9 cases, hot-crush injury in 2 cases, chemical burn in 1 case, and electric burn in 1 case. The disease duration was 6 months to 6 years (mean, 2.3 years). After excising scar, releasing contracture and interrupting adherent muscle and tendon, the soft tissues and skin defects ranged from 6.0 cm×4.5 cm to 17.0 cm×7.5 cm. The radial artery retrograde island flap was used in 2 cases, the pedicled abdominal flaps in 4 cases, the thoracodorsal artery perforator flap in 2 cases, the anterolateral thigh flap in 1 case, and the scapular free flap in 4 cases. The size of flap ranged from 6.0 cm×4.5 cm to 17.0 cm×7.5 cm. ResultsAll flaps survived well. Venous thrombosis of the pedicled abdominal flaps occurred in 1 case, which was cured after dressing change, and healing by first intention was obtained in the others. The mean follow-up time was 8 months (range, 6-14 months). Eight cases underwent operation for 1-3 times to make the flap thinner. At last follow-up, the flaps had good color, and the results of appearance and function were satisfactory. ConclusionSevere palm scar contracture deformity can be effectively repaired by proper application of different flaps.
Objective To evaluate the cl inical effect and the pathological characteristics of acellular allogeneic dermal matrix in repairing unstable burn scar. Methods From January 2007 to June 2008, 19 cases of unstable burn scars (24 parts) were treated, including 16 males (20 parts) and 3 females (4 parts) with a median age of 27 years (range, 3-58 years). Theinjury was caused by flame (14 cases, 18 parts), electricity (4 cases, 5 parts), and hot water (1 case, 1 part). The unstable burn scars located on hands (8 cases), forearms (2 cases), thighs (3 cases), legs (2 cases), feet (2 cases), chest (1 case), and abdomen (1 case). Scar formed for 3 months to 1 year. The area of defect varied from 7 cm × 5 cm to 22 cm × 15 cm after scar removal. Defects were covered with acellular allogeneic dermal matrix and autogenous spl it-thickness skin graft. At 6-18 months after operation, the pathological observations of the epidermis, the basal membrane, and structural components of the dermis were done. Results All wounds healed by first intention. Scar ulcer disappeared completely in 18 cases and the composite skin grafts all survived. Some bl isters occurred in 1 case and were cured after dressing changing. All patients were followed up 10 months to 2 years (18 months on average). The grafted-skin was excellent in the appearance, texture, and elasticity. The function recovered well. Only superficial scar was observed at skin donor sites. Pathological observation showed that the epidermis and the basal membrane of the skin grafts were similar to that of normal skin, and no significant difference was found in newly capillaries between them. Collagen fibers arranged regularly, and there were few inflammatory cells in the matrix. Conclusion Acellular allogeneic dermal matrix with autogenous spl it-thickness skin graft may effectivly repair the wound after removing the unstable burn scar, and its structure is similar to that of normal skin.
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.
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.