Boyun defektlerinin preekspanse oksipito-serviko-dorsal ada flepleri ile onarımı

Amaç: Boyun cildi defektleri genellikle kontraktür sebestleştirilmesi veya malign/benign tümör eksizyonu sonrası meydana gelir. Sık kullanılan boyun cilt rekonstrüksiyon yöntemleri Z-plastiler, cilt pediküllü veya perforatör flepler ve serbest fleplerdir. Bunlara ek olarak son zamanlarda pre-ekspanse perforator cilt flepleri cilt defekt rekonstrüksiyonlarında sıkça kullanılmaktadır. Cilt fleplerinin ekspansiyonu rekonstrüksiyon ve donor alan onarımı için daha fazla doku sağlar. Ayrıca defektlerin yakın doku ile rekonstrüksiyonu, renk ve yapı uyumu açısından iyi sonuçlar verir.Gereç ve Yöntem: Bu çalışmada 7’si boyun kontraktür açılması sonrası ve 1’i konjenital dev kıllı nevus eksizyonu olmak üzere boyunda cilt defekti olan 8 hasta değerlendirildi. Tüm defektlere toplam 11 adet preekspanse oksipito-serviko-dorsal ada flebi ile onarım uygulandı. En geniş flep boyutu 9x23 cm iken en küçük flep boyutu 5x13 cm idi. Ortalama hasta yaşı 15.8 idi ve ortalama ekspansiyon zamanı 11.5 hafta idi.Bulgular: Hastalar ortalama 27,8 ay takip edildi. bir hastada doku genişletici ekspozisyonu oluşurken başka bir hastada %50 flep nekrozu görüldü. Tüm hastalarda estetik ve fonksiyonel sonuçlar kabul edilebilir seviyelerdeydi.Sonuç: Preekspanse oksipito-serviko-dorsal flep, orta büyüklükteki boyun defektlerinde kullanılabilecek uygun bir rekonstrüksiyon seçeneğidir. Tanımlanan flep, özellikle ön servikal ve torakal cildi uygun olmayan ve dorsal serviko-dorsal cildi sağlam olan hastalarda uygulanabilecek yeni bir rekonstrüktif metod olarak sunulmuştur.

Reconstruction of neck defects by pre-expanded occipito-cervico-dorsal island flaps

Purpose: Neck defects usually occur after burn contracture release and benign or malignant neck tumor excisions. Frequently used neck skin reconstruction methods are skin grafting, Z-Plasties, skin pedicled or perforator flaps, and free flaps. Pre-expanded perforator skin flaps are useful options for skin defect reconstructions. Pre-expansion of the skin flap provides more tissue for the reconstruction and donor area closure. Additionally, defect reconstructions used by adjacent skin maintain a good tissue colour and texture match with the defect. Material and Methods: In this study, 8 patients (neck burn contracture release (n=7) and congenital giant hairy nevus excision (n=1)) whose neck defects were reconstructed with 11 pre-expanded occipito-cervico-dorsal perforator island flaps were evaluated. The maximum and minimum flap sizes were 9x23 cm and 5x13 cm respectively. Mean age of the patients was 15.8 and mean expansion time was 11.5 weeks. Results: Mean follow-up time was 27.8 months. We encountered an expander exposition in one case and 50% flap necrosis in another case. Aesthetic and functional improvement was observed in all patients. Conclusion: The pre-expanded occipito-cervico-dorsal perforator island flap is useful in moderate sized lateral neck defects. The aforementioned flap provides good tissue compliance and colour with neck and minimal donor area morbidity. It is a new useful reconstructive method in patients with lateral neck defects, who have a healthy cervico-dorsal skin and do not have useful ventral skin.

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  • Grishkevich VM. Unilateral cervical burn scar deformity cervicothoracic flap a new approach. J Burn Care Res. 2012 ;33:26-31. with contralateral
  • Matsumine H, Sakurai H, Nakajima Y, Kubo K, Higuchi R, Nozaki M. Use of a bipedicled thin groin flap in reconstruction of postburn anterior neck contracture. Plast Reconstr Surg. 2008;122:782–5.
  • Nath S, Erzingatsian K, Simonde S. Management of postburn contracture of the neck. Burns. 1994;20:438–41.
  • Xiaobo Y, Yanyong Z, Haiyue J, Hongxing Z, Bo P, Lei L . Aesthetic and functional restoration of anterior neck scar contracture using bipedicled expanded forehead flap. Burns. 2011;37:1444-8.
  • Acartürk TO. Aesthetic reconstruction of the postburn neck contracture with a preexpanded anterolateral thigh free flap. J Craniofac Surg. 2014;25:23-6.
  • Kulahci Y, Sever C, Uygur F, Oksuz S, Sahin C, Duman H. Preexpanded pedicled thoracodorsal artery perforator flap for postburn axillary contracture 2011;31:26–31. Microsurgery.
  • Grishkevich VM, Grishkevich M. Postburn neck lateral contracture: anatomy and treatment. a new approach. J Burn Care Res. 2015;36:e294-9.
  • Grishkevich VM, Grishkevich M, Menzul V. Postburn neck anterior contracture treatment in children with scar-fascial local trapezoid flaps: a new approach. J Burn Care Res. 2015;36:e112-9.
  • Oksüz S, Ulkür E, Tuncer S, Sever C, Karagöz H. Elbow reconstruction with a pedicled thoracodorsal artery perforator flap after excision of an upper- extremity giant hairy nevus. J Plast Reconstr Aesthet Surg. 2013;66:566-9.
  • Hocaoğlu E, Aydin H. Preexpanded perforator flaps of the dorsolateral trunk in pediatric patients. Plast Reconstr Surg. 2013;131:1077-86.
  • Margulis A, Adler N, Eyal G. Expanded deep inferior epigastric artery perforator flap for reconstruction of the posterior neck and the upper back in a child with giant congenital melanocytic nevus. J Plast Reconstr Aesthet Surg. 2010;63:703–5.
  • Zang M, Zhu S, Song B, et al. Reconstruction of extensive upper extremity defects using pre- expanded oblique perforator-based paraumbilical flaps. Burns. 2012;38:917–23.
  • Song B, Zhao J, Guo S, Yi C, Liu C, He L, Li Y, Shao J, Zhang X. Repair of facial scars by the free expanded deltopectoral flap. Plast Reconstr Surg. 2013;131:200-8.
  • Xie F, Wang J, Li Q, Zhou S, Zan T, Gu B, et al. Resurfacing large skin defects of the face and neck with expanded subclavicular flaps pedicled by the thoracic branch of the supraclavicular artery. Burns. 2012;38:924–30.
  • Vinh VQ, Ogawa R, Van Anh T, Hyakusoku H. Reconstruction of neck scar contractures using supraclavicular flaps: retrospective study of 30 cases. Plast Reconstr Surg. 2007;119:130–5.
  • Ogawa R, Hyakusoku H, Murakami M, Gao JH. Clinical and basic research on occipito-cervico-dorsal flaps: including a study of the anatomical territories of dorsal trunk vessels. Plast Reconstr Surg. 2004;113:1923-33.
  • Hyakusoku H, Gao JH. The “super-thin” flap. Br J Plast Surg. 1994;47:457-64.
  • Hyakusoku H, Pennington DG, Gao JH. Microvascular augmentation of the super-thin occipitocervico- dorsal flap. Br J Plast Surg. 1994;47:465-9.
  • Tsai FC. A new method: perforator-based tissue expansion for a preexpanded free cutaneous perforator flap. Burns. 2003;29:845–8.
  • Saint-Cyr M, Schaverien M, Rohrich RJ. Preexpanded second intercostal space internal mammary artery pedicle perforator flap: case report and anatomical study. Plast Reconstr Surg. 2009;123:1659–64.
  • Ashab Yamin MR, Mozafari N, Mozafari M, Razi Z. Reconstructive surgery of extensive face and neck burn scars using tissue expanders. World J Plast Surg 2015;4:40-9.
Cukurova Medical Journal-Cover
  • ISSN: 2602-3032
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 1976
  • Yayıncı: Çukurova Üniversitesi Tıp Fakültesi