자연스러운 목턱각 성형을 위한 안면부 조직확장술 = The Facial Tissue Expansion to Achieve the Natural Cervicomental Angle

다국어 초록 (Multilingual Abstract)

Purposes: Wide scars occurring on the lower face and neck are a source of both functional and esthetic problems. Consequently, we can use skin grafts, pedicled flaps, free flaps, and tissue expansion for the reconstruction of this area. Compared with other reconstruction techniques, tissue expansion is advantageous in that it enables the maintenance of a color and texture similar to that of the adjacent tissue. However, the conventional method of tissue expansion has been reported to lead to an unnatural cervicomental angle and to the deformity of adjacent structures. We have therefore made efforts to prevent these problems through the use of several operative procedures.
Methods: Forty-one patients with lower facial and cervical scars underwent tissue expansion. The tissue expansion was performed using a rectangular-shaped Nagosil® tissue expansion device. On insertion of the tissue expander, the intermediate area of superficial fat layer was dissected and then the tissue expander was inserted to make a flap that was as thin as possible. In advancement of the flap, a capsule—formed by the tissue expander—was used for the interrupted fixed suture of the flap to the fascia of the platysma muscle of the neck. This procedure was performed multiple times and also performed between the flap and the periosteum of the mandible, such that the tension was removed during the suture of the flap margin. Finally, the patients were fitted with a Jobst® facial garment in order to stabilize the operation site at least twelve months.
Results: The most prevalent location of the scar was the cheek (15 cases), followed by the chin in 14 cases and the neck in 12 cases. The mean size of scar was 55.7 ± 39.4 ㎠.
Conclusions: Using our procedures, we have experienced no significant deformities and have also achieved a more natural cervicomental angle in the patients.

참고문헌 (Reference)

1 Radovan C, "Tissue expansion in soft-tissue reconstruction" 74 : 482-, 1984

2 Antonyshyn O, "Tissue expansion in head and neck reconstruction" 82 : 58-, 1988

3 Kawashima T, "Tissue expansion in facial reconstruction" 94 : 944-, 1994

4 Neale HW, "Tissue expanders in the lower face and anterior neck in pediatric burn patients: limitations and pitfalls" 91 : 624-, 1993

5 Neumann CG, "The expansion of an area of skin by progressive distention of a subcutaneous balloon; use of the method for securing skin for subtotal reconstruction of the ear" 19 : 124-, 1957

6 Hyakusoku H, "The ''super-thin'' flap" 47 : 457-, 1994

7 van Rappard JH, "Surface-area increase in tissue expansion" 82 : 833-, 1988

8 Hurvitz KA, "Pediatric cervicofacial tissue expansion" 69 : 1509-, 2005

9 Cherry GW, "Increased survival and vascularity of random-pattern skin flaps elevated in controlled expanded skin" 72 : 680-, 1983

10 Pasyk KA, "Histopathology of human expanded tissue" 14 : 435-, 1987

11 Austad ED, "Complications in tissue expansion" 14 : 549-, 1987

12 Elias DL, "Applications and complications of tissue expansion in pediatric patients" 26 : 15-, 1991