局部皮瓣成形术

Basic defect closure technique

Surgical interventions on the face (including ophthalmic surgery, maxillofacial and ENT operations) often require the elimination of skin defects. In the presence of small skin defects, basic local tissue plasty becomes the optimal choice.

The essence of the technique lies in careful detachment and subsequent approximation of the wound edges. The mobilized edges must be sutured through the entire thickness. A critically important rule at this stage is the placement of sutures strictly without tension. This ensures ideal alignment of the tissue layers and prevents the formation of an aesthetically unacceptable retracted scar. In cases where sharp tissue tension cannot be avoided, the surgeon resorts to making additional relaxing incisions placed parallel to the main wound.

Skin flap plasty

In situations where the defect is more extensive, skin flap plasty is used. These flaps are designed in such a way as to preserve a broad base — a prerequisite for maintaining adequate blood supply and full innervation of the transposed area. The movement of the flap onto the exposed surface of the defect is carried out by sliding, while avoiding any kinking.

A specific technique has been developed for rectangular defects:

1. Perpendicular incisions are made on opposite sides of the wound.
2. Quadrilateral flaps with broad bases are formed.
3. These flaps are detached and advanced over the defect (interdigitated from two sides or from one side only).

The advantage of using local flaps is that defects are closed with full-thickness skin that has an absolutely identical appearance (color, texture) to the surrounding tissue. Among the disadvantages are the formation of new scars around the perimeter of the former defect and the impossibility of obtaining a double flap, which is sometimes necessary, for example, when forming the alar of the nose.

Transposition flaps (Limberg flap)

For contracting scars on the face, the method of transposition flaps is widely used. The essence of this method is plasty with opposing symmetrical triangles. Technically, this is performed as follows:

• Parallel incisions are made in opposite directions from the ends of the excised scar.
• The scar is excised, resulting in two opposing triangular flaps.
• The flaps are mobilized and subjected to mutual exchange (moved one over the other).

In this way, the defect formed by scar tension is filled.

In cases where the surrounding tissue has varying mobility, plasty with asymmetrical triangles is used. The principle of angle formation here is strictly regulated: the triangle with the larger angle at the apex is created on the less mobile part of the skin, while the triangle with the acute angle is placed on the mobile part. For example, when eliminating a scar near the medial canthus of the eye, the wide triangle is taken from the less mobile skin under the eyelid, and the narrow triangle is taken from the tissues between the nasal dorsum and the medial canthus.

Pedicle flap plasty and skin strip

An alternative method is pedicle flap plasty. Such a flap is harvested from tissues near the defect and must match in shape and size. The pedicle of the flap can be short or long. A long pedicle gives the surgeon the opportunity to transfer the flap over an area of undamaged skin. At the same time, it is important to ensure that the vessels running within the pedicle are not compressed when the pedicle is folded. The operation ends with the closure of the wound at the donor site. The disadvantage of this method is that it does not provide material for replacing large defects or forming double flaps.

There is also a strict technique for forming a tubular flap (skin strip):

1. A skin strip of the required length and width is outlined with two parallel incisions (the ratio should be 3:1 for adequate nutrition).
2. The incision is made through the skin, subcutaneous tissue, and superficial fascia.
3. The strip is rolled into a tube with the skin facing outward. The edges are sutured, while the subcutaneous fat should not protrude beyond the edges of the skin and interfere with adaptation.
4. The defect at the harvest site is closed with interrupted silk sutures.

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该主题的其他拓展内容

• Ophthalmic surgery: eyelid operations
• Maxillofacial surgery: lip and alar plasty
• Topographic anatomy of the superficial fascia of the face and neck
• Types and techniques of interrupted surgical sutures
• Blood supply to facial skin flaps

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本资料由 WhiteCoat Pro 讲师根据医学院校教学大纲编写。仅供教育参考。