带蒂足底内侧动脉穿支皮瓣转移修复同侧足跟功能区微小创面

目的:探讨带蒂足底内侧动脉穿支皮瓣转移修复足跟功能区微小创面的临床效果。方法:自2012年1月至2015年12月我科收治的足跟软组织缺损病人17例,男12例,女5例,其中左侧足跟损伤10例,右侧足跟损伤7例,伴跟腱损伤的8例。致伤原因:车祸伤8例,机器绞伤4例,锐器伤3例,电击伤2例,年龄12~55岁,平均27岁,清创后创面面积最大为6 cm×5 cm,最小为3 cm×2.5 cm。临床均采用足底内侧动脉穿支皮瓣带蒂转移修复,供瓣区植皮修复。对跟腱损伤的病例同时于修复跟腱损伤。结果:术后随访6~24个月,17例皮瓣完全存活,未发生皮瓣血管危象,供瓣区皮片移植均一期存活。皮瓣感觉恢复良好,两点辨别觉6~9 mm,平均7 mm,术后患者穿鞋无疼痛不适,行走正常,无溃疡发生,效果满意。结论:足底内侧动脉穿支皮瓣供区隐蔽,血供可靠,对供区损伤较小,转移修复后可恢复良好的皮瓣感觉,是修复足跟功能区微小创面的理想组织瓣之一。     

封闭式引流在四川地震伤员创面治疗中的应用

目的:探讨封闭式负压引流技术在地震伤皮肤或软组织损伤创面治疗中的疗效.方法:对2008年5月至2008年7月我院8例有皮肤、软组织损伤及伤口感染的四川地震伤员,采用封闭式持续负压引流治疗.结果:VSD治疗时间为7-27天(平均12.8天),行游离植皮、带血管蒂皮瓣转移或直接缝合修复创面.其中3例因气性坏疽截肢术后、创面不规则伴随骨外露及感染,行多次负压引流,最后行皮瓣转移及游离植皮修复创面.结论:与传统的引流及创面处理方式相比.VSD能消除感染,充分引流和刺激创面肉芽组织快速生长,促进创面愈合,在地震伤创面的治疗中发挥重要作用.     

VSD联合带腓肠神经营养血管逆行岛状皮瓣治疗胫骨慢性骨髓炎的术后护理及功能锻炼

目的:观察封闭式负压引流(vacuum sealing drainage,VSD)联合带腓肠神经营养血管逆行岛状皮瓣治疗胫骨慢性骨髓炎的术后护理及功能锻炼的效果.方法:2009年1月-2009年11月,收治28例胫骨慢性骨髓炎患者,采用VSD待创面肉芽组织新鲜、感染控制后,用带腓肠神经营养血管逆行岛状皮辩治疗胫骨慢性骨髓炎,术后予以特殊护理与康复治疗.结果:28例患者术后予以特殊护理与康复治疗,皮瓣顺利成活.28例患者均获随访,随访时间1～10个月.皮辩与周围皮肤色泽相似,无臃肿,两点辨别觉6～8mm.术后能穿鞋正常行走,皮瓣受力处无破溃.结论:VSD联合带腓肠神经营养血管逆行岛状皮瓣治疗胫骨慢性骨髓炎,术后予以特殊护理与康复治疗,疗效满意     

游离植皮联合负压封闭引流治疗骨科创面的临床研究

目的:观察游离植皮联合负压封闭引流(vacuumsealingdrainage,后文简称VSD)对骨科创面的疗效,并与植皮后传统加压包扎相比较,为临床实践提供更好的治疗方法。方法:对广州中医药大学第一附属医院创伤骨科2008年3月至2010年2月收治的65例感染创面病例采取手术清创后予VSD引流,合理应用抗生素,创面感染得到控制后,创面干净,肉芽生成良好,外露的肌腱、骨膜表面有新鲜的肉芽组织覆盖,达到植皮的要求后,随机分成两组,其中30例(实验组)采用游离植皮联合VSD法闭合创面,35例(对照组)采用游离植皮加压包扎植皮区,对两组术后的平均换药次数、创面平均愈合时间、植皮成活率情况、平均住院时间(植皮后)、平均抗生素应用次数(植皮后)进行统计学分析,采用t检验和卡方检验,对此两种方法进行评价。结果:植皮联合VSD组与植皮加压包扎组,在平均换药次数、创面平均愈合时间、植皮成活率、平均住院时间(植皮后)、平均抗生素应用次数(植皮后)的对比,有显著性差异(P<0.05)。结论:创面达到游离植皮条件后,游离植皮联合VSD负压引流可以促使皮片黏附,保持创面洁净,避免皮下渗液积聚,有利于皮片的存活,与植皮加压包扎组相比,减少了平均换药次数,缩短创面平均愈合时间及平均住院时间(植皮后),减少抗生素平均应用次数,提高了植皮成活率,说明游离植皮联合VSD组优于游离植皮加压包扎组,游离植皮联合VSD法治疗骨科创面有显著疗效。该手术方法操作简单,术后护理方便,是一种较理想的植皮后的固定方法,有利于创面的愈合,值得临床推广应用。     

游离植皮联合负压封闭引流治疗骨科创面的临床研究

目的：观察游离植皮联合负压封闭引流（vacuumsealingdrainage,后文简称VSD）对骨科创面的疗效,并与植皮后传统加压包扎相比较,为临床实践提供更好的治疗方法。方法：对广州中医药大学第一附属医院创伤骨科2008年3月至2010年2月收治的65例感染创面病例采取手术清创后予VSD引流,合理应用抗生素,创面感染得到控制后,创面干净,肉芽生成良好,外露的肌腱、骨膜表面有新鲜的肉芽组织覆盖,达到植皮的要求后,随机分成两组,其中30例（实验组）采用游离植皮联合VSD法闭合创面,35例（对照组）采用游离植皮加压包扎植皮区,对两组术后的平均换药次数、创面平均愈合时间、植皮成活率情况、平均住院时间（植皮后）、平均抗生素应用次数（植皮后）进行统计学分析,采用t检验和卡方检验,对此两种方法进行评价。结果：植皮联合VSD组与植皮加压包扎组,在平均换药次数、创面平均愈合时间、植皮成活率、平均住院时间（植皮后）、平均抗生素应用次数（植皮后）的对比,有显著性差异（P〈0.05）。结论：创面达到游离植皮条件后,游离植皮联合VSD负压引流可以促使皮片黏附,保持创面洁净,避免皮下渗液积聚,有利于皮片的存活,与植皮加压包扎组相比,减少了平均换药次数,缩短创面平均愈合时间及平均住院时间（植皮后）,减少抗生素平均应用次数,提高了植皮成活率,说明游离植皮联合VSD组优于游离植皮加压包扎组,游离植皮联合VSD法治疗骨科创面有显著疗效。该手术方法操作简单,术后护理方便,是一种较理想的植皮后的固定方法,有利于创面的愈合,值得临床推广应用。     

负压封闭引流技术促进慢性复杂创面的愈合

目的:探讨负压封闭引流技术(VSD)对慢性复杂创面愈合的治疗效果。方法:选取各类慢性复杂性创面患者共65例,病程均超过3个月,将65例患者随机分为VSD组(35例)及对照组(30例)。VSD组定期更换VSD辅料;2周后视创面愈合情况,选择继续VSD治疗,或行II期修复治疗(直接拉拢缝合,皮片移植,或皮瓣移植修复)。对照组的治疗采用常规换药,即以凡士林油纱布及无菌纱布覆盖创面,内置引流条,每12 h换药一次。两组创面于治疗前及治疗后各个时间点分别对比创面愈合率及创面组织细菌计数。结果:VSD治疗组患者全部愈合,治愈率达100%,对照组30例患者中治愈率为86.7%。两组治愈率相比无明显统计学差异(P0.05)。VSD治疗组平均愈合时间为22±3.3天,对照组平均愈合时间为35±5.8天,两组愈合时间的差异具有统计学意义(P0.01)。治疗后相同检测时间点VSD组创面细菌含量显著低于对照组,两组创面细菌含量的差异具有统计学意义(P0.05)。结论:负压封闭引流技术(VSD)在提高慢性复杂创面的愈合率及清除创面细菌方面具有显著的效果。     

VSD用于足踝部皮肤软组织缺损行腓动脉穿支皮瓣修复的效果分析

目的探讨负压封闭引流(vacuum sealing drainage,VSD)用于足踝部皮肤软组织缺损行腓动脉穿支皮瓣修复的临床效果。方法将2014年1月~2016年2月我院收治的24例足踝部皮肤软组织缺损患者采用VSD联合腓动脉穿支皮瓣进行修复,观察治疗后皮瓣成活率、创面愈合效果及踝关节功能改善情况,并对治疗前后美国骨科足踝外科协会(AOFAS)踝-后足评分进行比较。结果治疗后皮瓣成活率为100%,创面、切口Ⅰ期愈合,踝关节功能优良率95.83%,治疗后AOFAS评分高于治疗前(P0.05)。结论 VSD能显著降低创面感染发生率,促进创面愈合和肉芽组织的生长,应用于足踝部皮肤软组织缺损行腓动脉穿支皮瓣修复的效果确切,值得临床推广应用。     

腓肠神经营养血管皮瓣修复跟骨骨折术后皮肤软组织缺损的临床研究

摘要 目的：探讨负压引流技术结合腓肠神经营养皮瓣在跟骨骨折钢板内固定术后皮肤软组织缺损的临床效果。方法：回顾性分析我院骨科2012年5月-2020年5月共31例跟骨骨折术后钢板外露,皮肤软组织缺损住院病人。纳入患者均使用负压引流技术结合腓肠神经营养皮瓣修复技术。创面给予彻底清创后行封闭负压吸引引流术,待创面新鲜后以腓肠神经营养皮瓣修复创面。对术后皮瓣成活情况;Maryland功能评分以及BMRC感觉功能评分进行综合评估。结果：术后2周时,28例皮瓣顺利成活,供区与受区伤口愈合良好,干燥、无渗出。3例术后出现皮瓣肿胀,皮瓣颜色发暗,伤口渗出较多,皮瓣边缘坏死,窦道形成等,给予切开引流、加强换药、敏感抗生素控制感染等治疗后,皮瓣成活。术后随访6-24个月皮瓣外观及功能恢复良好,无创面再坏死,裂开,感染等情况出现。其中2例再次入院行皮瓣整形术。术后6个月时,Maryland功能评分：优：17例;良：11例;优良率为：90.3%。BMRC感觉功能评分：S3-S4：20例;S2：8例;S1：3例。结论：腓肠神经营养皮瓣联合封闭负压吸引技术在跟骨骨折钢板内固定术后皮肤软组织缺损的治疗中能够缩短治疗时间,操作简单,疗效确切,可获得良好的修复效果。     

负压封闭引流治疗厌氧菌感染创面的临床观察

目的:观察负压封闭引流联合双氧水冲洗治疗厌氧菌感染创面的临床治疗效果。方法:收集我院收治的创面厌氧菌感染患者60例,随机分为两组。其中,对照组(30例)患者采用常规换药治疗创面厌氧菌感染,VSD组(30例)患者给予负压封闭引流并辅以双氧水冲洗治疗。观察并比较两组患者厌氧菌清除率,以及创面愈合情况。结果:VSD组创面厌氧菌感染率明显低于对照组,创面愈合效果优于对照组,差异有统计学意义(P0.01)。结论:负压封闭引流不仅能够有效控制感染创面厌氧菌生长,而且可以有效促进创面愈合,对临床具有指导意义。     

骨髓炎患者的护理体会

目的探讨外伤性胫骨缺损所致骨髓炎的护理措施。方法对2008年1月~2014年10月我科收治的外伤性胫骨缺损所致骨髓炎患者25例的临床护理资料进行总结分析。结果 25例患者均采用局部清创+VSD负压吸引术后再行胫骨缺损髂骨植骨+带血管蒂皮瓣移植术,其中愈合24例,1例骨髓炎复发,行X线显示骨生长,给予切开引流,局部抗生素冲洗,并进行第2次手术后愈合。结论外伤性胫骨缺损所致骨髓炎,采用局部清创+VSD负压吸引术后再行胫骨缺损髂骨植骨+带血管蒂皮瓣移植术治疗的临床效果良好,同时精心的护理、细致的病情观察,更能有效预防并发症的发生,促进疾病康复。     

带腓肠腱膜的腓肠神经营养皮瓣修复KuwadeⅣ型跟腱缺损

目的:回顾性分析带腓肠肌腱膜的腓肠神经营养皮瓣修复KuwadeⅣ型跟腱缺损的临床病例,探讨其手术注意事项及治疗经验。方法:总结2008年5月-2013年8月收治的KuwadeⅣ型跟腱缺损19例,应用带腓肠肌腱膜的腓肠神经营养皮瓣进行一期修复。7例为新鲜损伤,12例为陈旧性缺损。19例跟腱缺损均伴有皮肤及软组织坏死,皮肤缺损范围为4.0 cm×6.0 cm-6.0cm×12.0 cm,跟腱缺损长度为5-9 cm,术中皮瓣切取范围为6.0 cm×5.5 cm-12.0 cm×8.0cm,腓肠腱膜切取范围5.5 cm×6.0cm-10.0 cm×6.0 cm;供区游离植皮修复。客观性评价指标包括关节跖屈、背伸动度及形态学,主观性评价采用AOFAS评分。结果:术后17例跟腱功能重建良好,2例感染控制不良,跟腱移植体部分坏死。皮瓣完全成活13例,创面Ⅰ期愈合。2例术后6天皮瓣远端表皮坏死,经换药后愈合。2例术后10天皮瓣远端部分坏死,经局部皮瓣移位修复愈合,2例感染控制不良者,皮瓣未愈合,移植跟腱部分坏死,经再次清创后,行阔筋膜条修复术,局部皮瓣移位修复。术后19例均获随访,随访时间6~24个月,平均18个月。术后皮瓣略臃肿,但不影响穿鞋,行走功能恢复良好,术后1年AOFAS评分平均80.31分。结论:带腓肠肌腱膜的腓肠神经营养皮瓣用于治疗KuwadeⅣ型跟腱缺损,可以同时修复皮肤及跟腱缺损,是一种较为理想的一期修复方法。     

Anterolateral thigh flap for abdominal wall reconstruction

The free or pedicled anterolateral thigh flap was introduced for the reconstruction of large abdominal wall defects. This flap is superior to the tensor fasciae latae musculocutaneous flap in several respects. These include the wide, reliable skin territory (which can reach the level of the knee) and the long pedicle. Therefore, a pedicled anterolateral thigh flap with reliable blood circulation can easily be positioned above the umbilicus. In addition, the free anterolateral thigh flap has greater freedom of orientation and can be used to repair larger abdominal wall defects than can the tensor fasciae latae flap. Seven patients in whom abdominal wall defects had been reconstructed with pedicled or free anterolateral thigh flaps were reviewed. Their average age was 47.1 years (range, 21 to 74 years), and the average follow-up period was 10.7 months (range, 2 to 21 months). The size of the abdominal wall defects ranged from 12 x 12 cm to 18 x 24 cm, and the size of the transferred flap ranged from 10 x 20 cm to 20 x 20 cm. Three flaps were pedicled and four were free, of which three incorporated the tensor fasciae latae flap. All flaps survived completely, and no postoperative abdominal hernias developed. Despite some variations in vascular anatomy and technical difficulties in elevating the anterolateral thigh flap, the authors conclude that the pedicled or free anterolateral thigh flap is superior to the tensor fasciae latae flap for reconstruction of large abdominal wall defects.     

Use of an adipofascial flap based on the proximal perforators of the ulnar artery to correct contracture of elbow burn scars: an anatomic and clinical approach.

Different techniques can be used to repair contracture of burn scars on the elbow, including local or distant pedicle flaps, muscle or myocutaneous flaps, free flaps, and tissue expanders. Among these, a pedicled adipofascial flap based on the most proximal two to four perforators of the ulnar artery (located 1 to 5 cm from the origin of the artery) can be anastomosed to form a sort of axially patterned blood supply within the fascia and subcutaneous fat. Therefore, no major vessel in the forearm need ever be severed. In addition, use of this type of flap preserves muscle function. The pedicled adipofascial flap described in this article allows for early rehabilitation because the flap is thin and pliable. Additional advantages are the easy and quick dissection and completion of the procedure in one stage. A detailed anatomic dissection of the flap was performed on 16 upper extremities from fresh cadavers; an injection study was also performed to determine the location and dimensions of the pedicle flap and its area of reach around the elbow. In the past 3 years, 14 flaps were used in 13 patients to repair elbow defects after release of burn scar contractures. Flap dimensions ranged from 4 x 7 cm to 6 x 14 cm (mean flap size, 74 cm). The results were very satisfactory.     

Posterior interosseous free flap with extended pedicle for hand reconstruction

The anatomy of the posterior interosseous vessels makes them suitable as a donor area of free flap. The skin island can be designed on the perforating vessels of the distal third of the forearm, up to the dorsal wrist crease, to increase the pedicle length (7 to 9 cm). A series of nine flaps transferred to reconstruct hand defects is presented. All flaps were designed over the dorsal distal forearm, and dimensions permitted direct closure of the donor site (up to 4 to 5 cm wide). Apart from a linear scar, donor morbidity was negligible. All transfers were successful. Although its dissection is somewhat tedious, the anatomy of the vascular pedicle is suitable for microanastomosis and the skin island is thin, although hairy. The posterior interosseous free flap with extended pedicle may be a good choice when limited amounts of thin skin and a long vascular pedicle are needed.     

Anterolateral thigh flap for postmastectomy breast reconstruction

Most postmastectomy defects are reconstructed by use of lower abdominal-wall tissue either as a pedicled or free flap. However, there are some contraindications for using lower abdominal flaps in breast reconstruction, such as inadequate soft-tissue volume, previous abdominoplasty, lower paramedian or multiple abdominal scars, and plans for future pregnancy. In such situations, a gluteal flap has often been the second choice. However, the quality of the adipose tissue of gluteal flaps is inferior to that of lower abdominal flaps, the pedicle is short, and a two-team approach is not possible because creation of the gluteal flap requires that the patient's position be changed during the operation. In 2000, five cases of breast reconstructions were performed with anterolateral thigh flaps in the authors' institution. Two of them were secondary and three were immediate unilateral breast reconstructions. The mean weight of the specimen removed was 350 g in the three patients who underwent immediate reconstruction, and the mean weight of the entire anterolateral thigh flap was 410 g. Skin islands ranged in size from 4 x 8 cm to 7 x 22 cm, with the underlying fat pad ranging in size from 10 x 12 cm to 14 x 22 cm. The mean pedicle length was 11 cm (range, 7 to 15 cm). All flaps were completely successful, except for one that involved some fat necrosis. The quality of the skin and underlying fat and the pliability of the anterolateral thigh flap are much superior to those of gluteal flaps and are similar to those of lower abdominal flaps. In thin patients, more subcutaneous fat can be harvested by extending the flap under the skin. Use of a thigh flap allows a two-team approach with the patient in a supine position, and no change of patient position is required during the operation. However, the position of the scar may not be acceptable to some patients. Therefore, when an abdominal flap is unavailable or contraindicated, the creation of an anterolateral thigh flap for primary and secondary breast reconstruction is an alternative to the use of lower abdominal and gluteal tissues.     

The concept of fillet flaps: classification, indications, and analysis of their clinical value

Tissue of amputated or nonsalvageable limbs may be used for reconstruction of complex defects resulting from tumor and trauma. This is the "spare parts" concept.By definition, fillet flaps are axial-pattern flaps that can function as composite-tissue transfers. They can be used as pedicled or free flaps and are a beneficial reconstruction strategy for major defects, provided there is tissue available adjacent to these defects.From 1988 to 1999, 104 fillet flap procedures were performed on 94 patients (50 pedicled finger and toe fillets, 36 pedicled limb fillets, and 18 free microsurgical fillet flaps).Nineteen pedicled finger fillets were used for defects of the dorsum or volar aspect of the hand, and 14 digital defects and 11 defects of the forefoot were covered with pedicled fillets from adjacent toes and fingers. The average size of the defects was 23 cm2. Fourteen fingers were salvaged. Eleven ray amputations, two extended procedures for coverage of the hand, and nine forefoot amputations were prevented. In four cases, a partial or total necrosis of a fillet flap occurred (one patient with diabetic vascular disease, one with Dupuytren's contracture, and two with high-voltage electrical injuries).Thirty-six pedicled limb fillet flaps were used in 35 cases. In 12 cases, salvage of above-knee or below-knee amputated stumps was achieved with a plantar neurovascular island pedicled flap. In seven other cases, sacral, pelvic, groin, hip, abdominal wall, or lumbar defects were reconstructed with fillet-of-thigh or entire-limb fillet flaps. In five cases, defects of shoulder, head, neck, and thoracic wall were covered with upper-arm fillet flaps. In nine cases, defects of the forefoot were covered by adjacent dorsal or plantar fillet flaps. In two other cases, defects of the upper arm or the proximal forearm were reconstructed with a forearm fillet. The average size of these defects was 512 cm2. Thirteen major joints were salvaged, three stumps were lengthened, and nine foot or forefoot amputations were prevented. One partial flap necrosis occurred in a patient with a fillet-of-sole flap. In another case, wound infection required revision and above-knee amputation with removal of the flap.Nine free plantar fillet flaps were performed-five for coverage of amputation stumps and four for sacral pressure sores. Seven free forearm fillet flaps, one free flap of forearm and hand, and one forearm and distal upper-arm fillet flap were performed for defect coverage of the shoulder and neck area. The average size of these defects was 432 cm2. Four knee joints were salvaged and one above-knee stump was lengthened. No flap necrosis was observed. One patient died of acute respiratory distress syndrome 6 days after surgery.Major complications were predominantly encountered in small finger and toe fillet flaps. Overall complication rate, including wound dehiscence and secondary grafting, was 18 percent. This complication rate seems acceptable. Major complications such as flap loss, flap revision, or severe infection occurred in only 7.5 percent of cases. The majority of our cases resulted from severe trauma with infected and necrotic soft tissues, disseminated tumor disease, or ulcers in elderly, multimorbid patients.On the basis of these data, a classification was developed that facilitates multicenter comparison of procedures and their clinical success. Fillet flaps facilitate reconstruction in difficult and complex cases. The spare part concept should be integrated into each trauma algorithm to avoid additional donor-site morbidity and facilitate stump-length preservation or limb salvage.     

Extending the reach of the heterodigital arterialized flap by vein division and repair

The heterodigital arterialized flap is ideal for nonsensory reconstruction of sizable soft-tissue defects in the proximal fingers, web spaces, and the hand. The inclusion of a dorsal vein augments the venous drainage of this digital island flap and avoids the problem of postoperative venous congestion, which is a common problem in digital island flaps. However, the presence of a dorsal vein pedicle inhibits flap mobility somewhat, and the reach of the flap is mainly limited to adjacent fingers. In situations that demand a transfer from a nonadjacent donor finger or when the reach from the adjacent donor finger is inadequate, the dorsal vein pedicle can be temporarily divided and then anastomosed microsurgically after flap transfer is performed. This enables the reach of the flap to be extended up to two fingers from the donor finger. The authors performed this "partially free" heterodigital arterialized flap in 11 consecutive patients between 1991 and 2001. The average size of the defects was 4.4 x 2.3 cm. All of the flaps survived completely, without any evidence of postoperative flap congestion. Healing of all of the flaps was primary and did not result in any scarring. All of the donor fingers had "normal" two-point discrimination of 3 to 5 mm. All of the donor fingers retained excellent or good total active motion, as graded by the criteria of Strickland and Glogovac.     

Clinical applications of free soleus and peroneal perforator flaps

Clinical applications of two free lateral leg perforator flaps are described: a free soleus perforator flap that is based on the musculocutaneous perforator vessels from one of the three main arteries in the proximal lateral lower leg, and a free peroneal perforator flap that is based on the septocutaneous or direct skin perforator vessels from the peroneal artery in the distal and middle thirds of the lateral lower leg. The authors applied free soleus perforator flaps to 18 patients and free peroneal perforator flaps to five patients with soft-tissue defects. The recipient site was the great toe in 14 patients, the hand and fingers in five patients, the leg in two patients, and the upper arm and the jaw in one patient each. The largest soleus perforator flap was 15 x 9 cm, and the largest peroneal perforator flap was 9 x 4 cm. Vascular pedicle lengths ranged from 6.5 to 10 cm in soleus perforator flaps and from 4 to 6 cm in peroneal perforator flaps. All flaps, except for the flap in one patient in the peroneal perforator flap series, survived completely. Advantages of these flaps are that there is no need to sacrifice any main artery in the lower leg, and there is minimal morbidity at the donor site. For patients with a small to medium soft-tissue defect, these free perforator flaps are useful.     

胸三角皮瓣并自体脂肪移植修复颌面部大面积缺损畸形

目的：探讨颌面部皮肤软组织大面积缺损凹陷的理想修复方法。方法：本组6例均为爆炸伤后颌面部皮肤软组织缺损及严重凹陷畸形,采用胸三角皮肤扩张形成带蒂皮瓣修复上述皮肤缺损及自体脂肪移植纠正残存凹陷畸形。手术分五步进行：1．胸三角深筋膜浅层埋植500mL-800mL皮肤扩张器并注水扩张3个月。2井艮据面颈部预计皮肤缺损大小及形状作皮瓣预制并面部局部皮瓣纠正器官移位。3．带蒂皮瓣转移修复颌面部缺损。4．蒂部延迟及断蒂微整形。5．自体脂肪移植。结果：所有皮瓣成活良好,皮瓣色质接近面颈部周围正常皮肤,缺损畸形修复,外观形态好,供区直接缝合无需植皮,取得了较好的面部改观效果。结论：对于面部大面积皮肤软组织缺损,合并面部凹陷、面部器官缺损及移位,采取胸三角扩张延迟预制皮瓣并自体脂肪移植修复可取得良好的整复效果,为颌面部战创伤畸形提供了理想的修复方法。