| Objective To investigate the clinical application value of dilated deltopectoral pedicle flaps repairing skin defect of face and neck in the postoperative.Methods1. Case selection: 60 cases of elder patients that the postoperative face and neck skin defect conducted skin graft prosthesis were retrospectively selected. Inclusion criteria:(1) Consistent with trauma, benign and malignant tumor resection, scar contraction after burn, etc. and the patients had plastic surgery intention with face and neck soft tissue defect.(2) Normal neck and shoulder skin on one side / both sides.(3) Consistent with the indications of skin expansion.(4)There was no clear surgical contraindications, can be tolerated with dilated deltopectoral pedicle flap in repairing surgery. Exclusion criteria:(1) Skin graft donor site or skin defect, infection,tumor, etc, which were not allowed to transplant the skin flap or donor skin flap transplantation.(2)Skin flap expansion insufficient with causes itself.(3) The combined clear surgical contraindications.2. Group and treatment: There were 30 cases included in the skin graft group that given regular free skin grafts, and another 30 cases given dilated deltopectoral flaps repair, listed as the dilatation group. To compared postoperative recovery area of skin contraction rate, patients satisfaction and complications between two group.3. Observation index: The dilatation group and graft group patients during follow-up after operation in 1 months,3 months,6 months,12 months,18 months. 1Observe the rate of skin contraction in two groups of patients after operation, The rate of contraction =(Immediate area after operation-Area measured at follow-up)/ Immediate area after operation ×100%.2Satisfaction of patients after 6 months of operation with self satisfaction questionnaire.3The incidence of postoperative complications was compared between the two groups.4. Statistical Methods: The resulting data were analyzed by using SPSS13.0 medical statistics software package, measurement data were said by expressed as mean ± standard deviation(±S),comparison between groups were used t test, Between groups was compared using the χ2test, such as P<0.05,said the difference was statistically significant.Results1.The dilatation group after 3 months,6 months,12 months the repair area of skin contraction rates were(1.96 ± 0.33)%,(4.34 ± 1.32)%,(6.85 ± 1.32)%,and significantly lower the skin graft group(2.41 ± 0.36)%,(6.71 ± 1.46)%,(8.36 ± 1.59)%(P <0.05).2. After the dilatation group of treatment cycle satisfaction rate was 70%, satisfaction scores was(7.01 ± 1.38) points, significantly lower than the skin graft group 96.67%,(8.71 ± 1.45) points(P<0.05).3. After surgery, the dilatation of group skin color satisfaction rate was 83.33%, satisfaction score was(8.32 ± 1.61) points, significantly higher than 70% of the skin graft group,(7.21 ± 1.52)points(P <0.05).4. The satisfactory rate of the skin elasticity texture was 90% with the dilatation group after treatment, satisfaction score was(7.83 ± 1.52) points, significantly higher than 76.66% of the skin graft group,(7.11 ± 1.52) points(P <0.05).5. The dilatation group after treatment satisfaction rate was 86.66%, satisfaction score of(7.75 ±1.53) points, significantly higher than the skin graft group 76.66%,(7.23 ± 1.54) points.6. After treatment, the soft tissue contraction satisfaction rate of the dilatation group was 90%,satisfaction scores for(8.32 ± 1.75) points and significantly higher than 80% of the skin graft group,(7.05 ± 1.86) points(P <0.05).7. The total satisfaction rate was 93.33% at 6 months after operation and the satisfaction score was(8.33 ± 1.54),which was significantly higher than the control group 83.33%,(7.12±1.53)(P<0.05).8. Dilatation group: the incidence of postoperative complications was 6.67%, there was 1 case of patients with skin flap distal local necrosis,1 case of skin flap distal skin blisters and he was cured after symptomatic treatment. Skin graft group, 4 cases were treated with local necrosis,in which 3cases were cured after dressing change and 1 case was failed, the incidence of postoperative complications was 10.33%(P<0.05)in the skin graft group.Conclusion The overall satisfaction is significantly higher than the free skin graft group that the dilated deltopectoral pedicle flap in transfer in repairing face and neck soft tissue defects. The skin contraction rate of repair area is significantly lower than the skin grafting surgery and postoperative complications were also significantly lower than the skin grafting surgery. The main complications will be local necrosis of the distal end of the flap or inflammatory reaction. |
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