Aesthetic reconstruction of the severely disfigured burned face:a creative strategy for a"natural"appearance using pre-patterned autogenous free flaps

作     者：Elliott H.Rose 

作者机构：Division of Plastic&Reconstructive SurgeryThe Mount Sinai Medical Center895 Park AvenueNew YorkNY 10075USA 

出 版 物：《Burns & Trauma》 (烧伤与创伤（英文）)

年 卷 期：2015年第3卷第2期

页      面：66-73页

学科分类：0401[教育学-教育学] 04[教育学] 

主　　题：Facial burns Facial reconstruction Autogenous reconstruction Microvascular free flaps Burn reconstruction Pre-patterned flaps Scapular flaps Pedicled forehead flaps Radial forearm flap Fascia lata slings Temporoparietal flaps 

摘      要：The author reviews his pioneering work in aesthetic restoration of the severely disfigured burn face first introduced in 1995 and refined over the past two decades. The reader will be exposed to the step by step approach to achieving cosmetic enhancement and functional rehabilitation of advanced facial burns. Thekeystoneof the autogenous reconstruction is the pre-patterned, sculpted microvascular free flap designed to fit like thepiece of a puzzleinto the aesthetic units of the face to replace disfiguring burn scars. Aggressive intraoperativesculptingis employed bothin situat the donor site and during the flap transfer to simulate the normal facial contours and planes. Comparisons of the author s approach are made to the whole spectrum of reconstructive modalities ranging from conventional grafting to expanded pre-fabricated flaps and even to CTA face transplants;advantages/disadvantages of each are discussed. The pre-patterned, sculpted microvascular (MV) free flap offers the benefit of a single-stage transfer of composite skin/soft tissue hiding the seams at the junction of facial planes. When harvested from distant donor sites, the donor deformities can easily be concealed. The MV free tissue transfer offers the substrate that can be sculpted into nuanced facial components as well as thepaletteupon which the face can be painted with creative camouflage makeup. The soft contour and texture of the autogenous patterned transfers translates into anaturalfacial appearance while preserving fluid motions of facial expression.