ترميم اسكار سوختگي در صورت و گردن با استفاده از فلپ فاسيوكوتانه ذوزنقه اي

Extended Vertical Trapezius Fasciocutaneous Flap in Face and Neck Burn Scar Reconstruction

ﺯﻣﻴﻨﻪ ﻭ ﻫﺪﻑ: ﺍﺳﺘﻔـﺎﺩﻩ ﺍﺯ ﻓﻠـﭗ ﭘﻮﺳﺘﻲ ﻫﻤـﺮﺍﻩ ﺑﺎ ﻓﺎﺳﻴـﺎﻱ ﻋﻤﻘـﻲ ﻭ ﺷﺒـﻜﻪ ﻋـﺮﻭﻗﻲ ﺁﻥ، ﺍﻣـﻜﺎﻥ ﺟـﺪﻳﺪﻱ ﺩﺭ ﻃـﺮﺍﺣﻲ ﻓﻠـﭗ ﺍﺳﺖ. ﻓﻠـﭗ ﻓﺎﺳﻴـﻮﻛـﻮﺗﺎﻧﻪ ﻃﻮﻟـﻲ ﻋﻀﻠﻪ ﺫﻭﺯﻧﻘﻪ )Longitudinal Trapezius Fasciocutaneous Flap( ﺩﺭ ﺍﺑﺘـﺪﺍ ﺩﺭ ﺳﺎﻝ 1996 ﻣﻌـﺮﻓﻲ ﺷــﺪ ﻭ ﻋﻠﻴـﺮﻏﻢ ﻓـﻮﺍﻳﺪ ﺯﻳﺎﺩﺵ ﺩﺭ ﻣﻘـﺎﻡ ﻣﻘﺎﻳﺴﻪ ﺑﺎ ﺳﺎﻳﺮ ﺭﻭﺵ ﻫﺎﻱ ﺭﻭﺗﻴـﻦ ﺍﺯ ﺁﻥ ﺯﻣـﺎﻥ ﺗﺎﮐﻨـﻮﻥ ﻣـﻮﺭﺩ ﺗﻮﺟﻪ ﻗـﺮﺍﺭ ﻧﮕـﺮﻓﺘﻪ ﺍﺳﺖ. ﻣﻮﺍﺩ ﻭ ﺭﻭﺵ ﻫﺎ: ﺍﺯ 16 ﻓﻠﭗ ﻓﺎﺳﻴﻮﻛﻮﺗﺎﻧﻪ ﺩﺭ 15 ﺑﻴﻤﺎﺭ ﺑﻪ ﻣﻨﻈﻮﺭ ﺗﺮﻣﻴﻢ ﺍﺳﻜﺎﺭﻫﺎﻱ ﺷﺪﻳﺪ ﮔـﺮﺩﻥ ﻭ ﻧﺎﺣﻴﻪ ﻣﻴﺎﻧﻲ ﺻﻮﺭﺕ ﺍﺳﺘﻔﺎﺩﻩ ﺷﺪ. ﭘﺎﻳﻪ ﻋـﺮﻭﻗﻲ ﺗﻤـﺎﻡ ﺍﻳﻦ ﻓﻠـﭗ ﻫﺎ ﺍﺯ ﺷﺎﺧﻪ ﻋﻤﻘﻲ ﺷﺮﻳﺎﻥ ﮔﺮﺩﻧﻲ ﻋﺮﺿﻲ )Transverse Cervical Artery( ﻭ ﺷﺎﻣﻞ ﻓﺎﺳﻴﺎﻱ ﭘﻮﺷﺎﻧﻨﺪﻩ ﻋﻀﻠﻪ ﺫﻭﺯﻧﻘﻪ ﺑﻮﺩﻧﺪ. ﺑﺮﺍﻱ ﻓﻠﭗ ﻫﺎﻱ ﺑﻠﻨﺪ ﺍﺯ ﺭﻭﺵ ﺗﺄﺧﻴـﺮﻱ )Delaying( ﺍﺳﺘﻔﺎﺩﻩ ﺷﺪ. ﻳﺎﻓﺘﻪ ﻫﺎ: ﺩﺭ 2 ﻓﻠـﭗ ﺑﻪ ﺩﻟﻴﻞ ﭘﺎﻳﻪ ﻃـﻮﻻﻧﻲ )ﺑﻴﺶ ﺍﺯ 10 ﺳﺎﻧﺘﻴﻤﺘـﺮ ﺍﺯ ﻟﺒـﻪ ﺗﺤﺘـﺎﻧﻲ ﻋﻀﻠﻪ( ﻧﻜـﺮﻭﺯ ﺍﻧﺘﻬﺎﻳﻲ ﻣﺨﺘﺼـﺮﻱ ﺩﻳﺪﻩ ﺷـﺪ )ﻛﻤﺘـﺮ ﺍﺯ 5 ﺳﺎﻧﺘﻴﻤﺘـﺮ(. ﻧﺘـﺎﻳﺞ ﻧﺸﺎﻥ ﺩﻫﻨﺪﺓ ﺁﻥ ﺍﺳﺖ ﻛﻪ ﻃﻮﻻﻧﻲ ﻛـﺮﺩﻥ ﻓﻠﭗ ﻓﺎﺳﻴـﻮ ﻛـﻮﺗﺎﻧﻪ ﺑﺮ ﭘﺎﻳﻪ ﺷﺎﺧﻪ ﻧـﺰﻭﻟﻲ ﺷﺮﻳﺎﻥ ﮔـﺮﺩﻧﻲ ﻋﺮﺿﻲ ﻣﻲ ﺗﻮﺍﻧﺪ ﻓﻠـﭗ ﺑﺎ ﻃﻮﻝ ﻣﻨﺎﺳﺒﻲ ﺭﺍ ﺍﻳﺠﺎﺩ ﻛﺮﺩﻩ ﻛﻪ ﻗـﺎﺩﺭ ﺑﺎﺷﺪ ﺗﻤﺎﻡ ﮔـﺮﺩﻥ ﻭ ﻗﺴﻤـﺖ ﻣﻴـﺎﻧﻲ ﺻﻮﺭﺕ ﺭﺍ ﺑﻪ ﺧـﻮﺑﻲ ﻭ ﺑﺪﻭﻥ ﻋﺎﺭﺿﻪ ﭘﻮﺷﺶ ﺩﻫﺪ. ﻧﺘﻴﺠﻪ ﮔﻴـﺮﻱ: ﻓﻠﭗ ﻓﺎﺳﻴﻮﻛﻮﺗﺎﻧﻪ ﻋﻤـﻮﺩﻱ ﺫﻭﺯﻧﻘﻪ ﺑﺎ ﺍﻳﺠﺎﺩ ﺑﺎﻓـﺖ ﺯﻳﺎﺩ ﺑﺎ ﻋـﺮﻭﻕ ﺧﻮﻧﻲ ﻣﻨﺎﺳﺐ ﻭ ﻧﺰﺩﻳﻜﻲ ﺁﻧﺎﺗﻮﻣﻴﻚ ﻫﻤﺮﺍﻩ ﺑﺎ ﺯﺍﻭﻳﻪ ﭼﺮﺧﺶ ﺑﺎﺯ ﻭ ﻣﺨﻔﻲ ﺑﻮﺩﻥ ﻣﺤﻞ ﺩﻫﻨﺪﻩ ﻓﻠﭗ، ﻣﻲ ﺗﻮﺍﻧﺪ ﺭﻭﺵ ﺳﺎﺩﻩ ﻭ ﻗﺎﺑﻞ ﺍﻋﺘﻤـﺎﺩﻱ ﺟﻬﺖ ﺗﺮﻣﻴﻢ ﺍﻭﻟﻴﻪ ﻧﻘﺎﻳﺺ ﻣﺨﺘﻠﻒ ﺩﺭ ﮔﺮﺩﻥ ﻭ ﻗﺴﻤﺖ ﻣﻴﺎﻧﻲ ﺻﻮﺭﺕ ﺑﺎﺷﺪ.

Introduction & Objective: Elevation of the skin with its deep fascia vascular network is a recent facility for flap design. Longitudinal trapezius fasciocutaneous flap introduced primarily at 1996 but did not receive enough attention, although it has many significant benefits comparing to the other available procedures. Materials & Methods: Sixteen trapezius fasciocutaneous flaps were used in 15 patients for severe scarring of the neck and mid face reconstruction. All flaps were based on the deep branch of the transverse cervical artery and included overlying fascia of trapezius muscle. Delaying was applied for very long flaps. Results: Two flaps developed minimal distal necrosis(less than 5 cm) due to longer pedicle (more than 10 cm below the muscle border).The result indicates that the extra-long, back fascia flap based on descending branch of transverse cervical artery could be formed long enough to reconstruct whole neck and safely transferred to mid face. Conclusions: The vertical trapezius fascio-cutaneous flap with its abundant tissue, excellent blood supply and anatomic proximity with wide arc of rotation and hidden donor site scar, provides a simple and reliable method for primary reconstruction of various mid - face and neck defects