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

Year 2016, , 472 - 478, 30.09.2016

Cengiz Eser Anıl Arif Olguner Serkan Sabancıoğularından Eyüphan Gencel

https://doi.org/10.17826/cukmedj.237485

Abstract

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.

Keywords

boyun defekti; ekspansiyon; pre-ekspanse; flep; perforatör; oksipito-serviko-dorsal.

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

Abstract

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.

Keywords

neck defect, expansion, pre-expanded, flap, perforator, occipito-cervico-dorsal

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