| [Objective]To retrospectively analyze the clinical effects of pre-expanded transverse carotid artery perforator flap grafting versus full-thickness skin slice grafting in the treatment of patients with severe neck scar contracture.[Methods]Case selection: 72 patients who came to our department for surgical repair treatment of neck scar contracture due to burns and scalds from January 2019 to December 2021 were retrospectively analyzed and divided into full-thickness flap group(18 cases)and expanded flap group(15 cases)according to the matching of inclusion and exclusion criteria,with the full-thickness flap group using full-thickness flap graft to repair neck scar contracture and the expanded flap group using pre The full-thickness flap group used full-thickness flap grafting to repair neck scar contracture,and the expanded flap group used pre-expanded transverse carotid artery perforator flap grafting to repair neck scar contracture.Observation indexes: 1)basic patient information,operation time,intraoperative bleeding and postoperative complications;2)regular postoperative outpatient followup in 1,3,6 and 12 months in both groups to collect data:(1)measurement of postoperative skin slice/flap contraction rate in the repair area;(2)measurement of postoperative chin and neck angle in the horizontal and supine positions;(3)use of the Vancouver Assessment Scale(VSS score)and the Patient and Observer Scar assessment scale(POSAS scale: containing both PSAS and OSAS scales)to assess the postoperative scarring of patients;(4)overall satisfaction,satisfaction with treatment time,and satisfaction with the elastic texture and color of the skin in the repair area 1 year after surgery.Statistical methods: SPSS26.0 statistical software was applied,and the mean±standard deviation((?)±S)was used for measurement data,and t-test for independent samples was used for comparison,and P<0.05 was considered statistically significant;Fisher’s exact probability method was used for comparison of count data,and P<0.05 was considered statistically significant.【Results】(1)The clinical data of gender,age,area of defect produced by scar excision and release,and area of skin slice/flap excision were compared between the two groups,and there was no statistical difference(P>0.05),and the data of the two groups were comparable.(2)Postoperative complications: 3 cases of partial necrosis occurred in the fullthickness flap group after surgery,2 cases healed after dressing exchange,1 case of graft failure and 2 implant repairs were performed,with a complication rate of16.67%;1 case of epidermal blistering at the distal end of the flap in the expanded flap group after surgery,healed after symptomatic treatment,with a complication rate of 6.67%,with statistical differences between the two groups(P<0.05).(3)Contraction rate(%)of skin flaps/flaps in the repair area: 0.76±0.13 in the dilated flap group at 1 month after surgery,compared with 0.79±0.18 in the full-thickness flap group,and the difference between the two groups was not statistically significant(P>0.05);the contraction rates at 3,6,and 12 months after surgery in the dilated flap group(2.01±0.35,4.98±1.02,and 6.44±1.16,respectively)were lower than those in the full-thickness skin flap group(3-,6-,and 12-month contraction rates: 2.73±0.23,7.05±1.32,and 9.66±1.12),and the differences between the two groups were statistically significant(p<0.01).(4)Changes in the chin-neck angle in plain view: 2.9±1.01 in the dilated flap group at1 month after surgery,compared with 3.4±0.21 in the full-thickness flap group at 1month after surgery,and the difference between the two groups was not statistically significant(p>0.05);changes in the chin-neck angle in plain view at 3,6 and 12 months after surgery in the dilated flap group(5.25+0.79,8.93±1.07,11.98±1.75,respectively),compared with that in the full-thickness flap group(p<0.01).),compared with the full-thickness skin slice group after surgery(8.1±1.03,19.1±1.64,23.73±1.23,respectively),the angular changes were reduced,and the differences between the two groups were statistically significant(p<0.01)(5)Change of chin-neck angle in elevation: 3.21±0.17 in 1 month after surgery in the dilated flap group,compared with 3.41±0.21 in the full-thickness flap group,the difference between the two groups was not statistically significant(p>0.05),and the change of chin-neck angle in elevation in 3,6 and 12 months after surgery in the dilated flap group(8.46±1.32,15.66±1.96,21.20±1.06,respectively),compared with the full-thickness skin slice group(11.21±1.97,23.48±2.07,37.01±0.96,respectively),the angular changes were smaller,and the differences between the two groups were statistically significant(p<0.01).(6)VSS value: the VSS value of the expanded flap group was 2.51±0.64 at 1 month after surgery,compared with 2.43±0.69 in the full-thickness flap group,the difference between the two groups was not statistically significant(p>0.05);the VSS values of the expanded flap group at 3,6 and 12 months after surgery,compared with the fullthickness flap group,the VSS values decreased,and the difference between the two groups was statistically significant(p<0.01).(7)PSAS values: PSAS values in the dilated flap group were 9.12±1.29 at 1 month after surgery,compared with 9.87±1.78 in the full-thickness flap group,and the difference between the two groups was not statistically significant(p>0.05);the dilated flap group was lower than the full-thickness flap group at 3,6,and 12 months after surgery,and the difference between the two groups was statistically significant(p<0.01).(8)OASA value: OSAS value was 10.16±1.63 in the expanded flap group at 1 month after surgery,compared with 10.23±1.85 in the full-thickness flap group,and the difference between the two groups was not statistically significant(p>0.05);the expanded flap group was lower than the full-thickness flap group at 3,6 and 12 months after surgery,and the difference between the two groups was statistically significant(p<0.01).(9)The treatment time satisfaction in the expanded flap group was 53.33%,which was lower than that in the full-thickness skin graft group(94.43%),and the difference between the two groups was statistically significant(P<0.05).The overall satisfaction rate at 1 year after surgery was 93.33% in the expanded flap group,higher than that of61.11% in the full-thickness skin graft group,and the difference between the two groups was statistically significant(P<0.05);the satisfaction rate of skin elasticity and texture at 1 year after surgery was 86.67% in the expanded flap group,higher than that of 44.44% in the full-thickness skin graft group,and the difference between the two groups was statistically significant(P<0.05);the patients’ skin The satisfaction rate of skin color 1 year after surgery was 86.67% in the expanded flap group,which was higher than that of 38.89% in the full-thickness skin graft group,and the difference between the two groups was statistically significant(P<0.05).[Conclusion] For the treatment of neck scar contracture,there was no significant difference between full-thickness skin flap graft and expanded transverse carotid artery penetrating flap graft in terms of treatment outcome at 1 month postoperatively,and it was easily accepted by patients because it required only one operation.Over time,starting from 3 months postoperatively,the expanded transverse carotid artery through-branch flap graft was superior to the full-thickness flap graft in maintaining the chin-neck angle,reducing the contraction of the repair area,and enhancing the appearance of the neck. |
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