Objective: To discuss the advantages of two flap contouring methods and to explore the best choice for the flap contouring.
Methods: From March 2002 to March 2006, 59 patients were admitted for a flap-contouring operation. Of the 59 patients, 40 (32 males, 8 females; average age, 34 years) underwent the multiphase lipectomy (the multiphase lipectomy group). The original flaps included the abdominal flap in 19 patients, the groin flap in 10, the thoracic flap in 4, the free anteriolateral thigh flap in 6, and the cross leg flap in 1. The flaps ranged in size from 6 cmX 4 cm to 32 cm x 17 cm. However, the remaining 19 patients (16 males, 3 females; average age, 28 years) underwent the one-phase lipectomy with skin graft transplantation(the one-phase lipectomy group). The original flaps included the abdominal flap in 4 patients, the groin flap in 6, the thoracic flap in 3, and the free anteriolateral thigh flap in 6. The flaps ranged in size from 4 cm x 3 cm to 17 cm x 8 cm. The results were analyzed and compared.
Results: In the multiphase lipectomy group, partial flap necrosis developed in 4 patients but the other flaps survived. The followed-up of 27 patients for 3 months to 2 years revealed that the flaps had a good appearance and texture, having no adhesion with the deep tissues. However, the flaps became fattened in 22 patients with their body weight gaining. The patients who had a flap >5 cm x 5 cm in area had their sensation functions recovering more slowly; only part of the sensations to pain and heat recovered. The two point discrimination did not recover. In the one-phase lipectomy group, total graft necrosis developed in 1 patient but the healing was achieved with additional skin graft transplantation; partial graft necrosis developed in 2 patients but the wounds were healed after the dressing changes; the remaining flaps survived completely. The follow-up of the 16 patients for 3 months to 3 years revealed that all the 16 patients had a good sensation recovery, 12 patients had the two point discrimination <15 mm, with no recurrence of the fattening of the flaps; however, the grafted skin had a more severe pigmentation, and no sliding movement developed between the skin and the tissue basement.
Conclusion: The multiphase lipectomy and the one-phase lipectomy with skin graft transplantation are two skin flap contouring methods, which have their own advantages and disadvantages. Which method is taken should be based on the repair location of the skin flap and the condition of the skin flap.