摘要目的 探讨应用额部、头皮扩张皮瓣联合半导体激光脱毛修复儿童先天性面部巨痣的可行性及治疗效果.方法 2013年1月至2015年12月,首都医科大学附属北京安贞医院整形外科收治儿童先天性面部巨痣患儿6例,均采用额部、头皮扩张皮瓣修复,联合半导体激光脱毛.治疗分3期:一期手术,根据病变大小,确定扩张器容量,于额部、头皮帽状腱膜下埋置扩张器,定期注水.二期手术,取出扩张器,切除面部巨痣,根据黑痣的大小、形状设计皮瓣,完全修复面部缺损.三期激光脱毛,扩张皮瓣完全愈合后,应用半导体激光对皮瓣进行脱毛4～6次,脱毛间隔时间约6周.结果 一期术中额部、头皮置入300～ 350 ml扩张器,扩张频率2次/周,扩张时间16 ～ 20周,平均18.7周,在扩张过程中均未发生扩张器渗漏、成角以及皮瓣血运障碍等并发症.二期手术中切取的额部、头皮扩张皮瓣面积12 cm×11 cm～20 cm×17 cm,术后1例皮瓣远端出现了静脉回流障碍,给予拆除部分缝线、针刺放血等处理,皮瓣血运恢复,未发生皮瓣坏死,其余皮瓣均存活良好;额部、头皮供区直接缝合,瘢痕隐蔽.三期半导体激光脱毛效果较好,随访1年均无复发,所有扩张皮瓣均无明显挛缩,颜色、质地与面部正常皮肤近似.结论 应用额部、头皮扩张皮瓣联合激光脱毛修复面部巨痣,为较大面部缺损的修复提供了可供选择的新供区.本方法效果可靠,一次手术即可完全修复面部巨痣,不仅缩短了手术次数及治疗时间,同时避免了面中部瘢痕形成及继发畸形的产生.

abstractsObjective To investigate the feasibility and therapeutic effect of frontal and scalp expanded skin flap combined with laser hair removal for children congenital facial giant nevi.Methods From January 2013 to December 2015,6 cases with congenital facial giant nevi were treated with expanded frontal and scalp skin flap combined with laser hair removal in the department of plastic surgery,An Zhen Hospital,Capital Medical University.The process of treatment could be divided into three stages.Stage 1:The expander capacity was determined according to the size of lesion.Expander was implanted under the galea aponeurotica in front and scalp,and expanded regularly postoperatively.Stage 2:The expander was removed and facial giant nevi was excised.The expanded skin flap was designed according to the shape and size of nevi.Stage 3:After the expanded skin flap healed completely,laser hair removal was performed for 4-6 times with 6 weeks of interval time.Results 300 ml to 350 ml expanders were selected with expanding frequency of 2 times a week.The expansion time lasted for 16 to 20 weeks(average,18.7 weeks).The complications such as leakage,angle and skin flap blood supply obstacle didnt occurr in the process of expansion.The size of frontal and scalp skin flap ranged from 12 cm × 11 cm to 20 cm × 17 cm.Venous drainage disorder happened in one flap and was treated by partial suture removal and acupuncturebleeding treatment.Skin flap necrosis didnt occurred.The defects at donor sites were sutured directly with inconspicious scar.The effect of semiconductor laser hair removal was good without recurrence during oneyear follow-up period.All expanded skin flaps had no obvious contraction with good match of color and texture.Conclusions This method provides a new selection of donor site for larger facial defect with reliable effet.The facial giant nevi could be excised completely and repaired in one operation with short operation time.The scar in middle face and secondary deformities can be avoided.