电影《Face off》（中译换脸）中，男主角为改变身份接受了“换脸”术。生活中，也有一些患者因为意外伤害而需要脸部整形重建手术。1995年，美国西奈山医疗中心的Elliot Rose博士首次介绍了其在严重烧伤患者脸部“美学重建”方面的开创性工作。近二十年以来，脸部“美学重建”的临床方法不断改善。其关键在于，预制高度匹配患者脸部特征的自体微血管游离瓣，将其移植到面部疤痕区域，精心“雕琢”，重塑“自然脸”。
Aesthetic reconstruction of the severely disfigured burned face: a creative strategy for a “natural” appearance using pre-patterned autogenous free flaps
Elliott H. Rose
How to cite this article: Eduardo Mansilla. Aestheticreconstruction of the severely disfigured burned face: a creative strategy fora “natural” appearance using pre-patterned autogenous free flaps. Burns &Trauma 2015, 3:16.
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. The “keystone” of the autogenous reconstruction is the pre-patterned, sculpted microvascular free flap designed to fit like the “piece of a puzzle” into the aesthetic units of the face to replace disfiguring burn scars. Aggressive intraoperative “sculpting” is employed both “in situ” at 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 the “palette” upon which the face can be painted with creative camouflage makeup. The soft contour and texture of the autogenous patterned transfers translates into a “natural” facial appearance while preserving fluid motions of facial expression.
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