摘要
目的：
观察应用股前外侧穿支皮瓣修复口腔颌面部肿瘤切除术后的修复效果,总结临床经验。
方法：
5例患者采取全身麻醉及气管插管。分两组医生穿插进行手术：口腔颌面外科组医生负责颈淋巴清扫、受区血管准备、肿瘤切除；手外科组医生进行大腿股前外侧穿支皮瓣的制备、分离、供区关闭。口外组医生将皮瓣对位缝合,手外科组医生在显微镜下吻合皮瓣血管与受区血管。最后由口外组医生关闭口腔及颈部创面。术中,按术前设计切开皮肤皮下,逐步切开分离皮下组织与深筋膜。遇到主要穿支后,确保主要穿支不受损伤；并沿着穿支血管追踪分离深筋膜、肌肉,直至获得所需长度及管径的血管蒂,供瓣区创面直接拉拢缝合。皮瓣移植时,先间断缝合皮瓣与受区创缘,再于显微镜下用8-0滑线吻合血管.。观察所有患者术后愈合情况,同时观察皮瓣是否坏死、供区伤口是否裂开等.。术后通过查阅病例资料、电话随访、门诊复查、术前术后对比照片等手段获取所需的信息.
结果：
4例患者所移植的皮瓣全部存活,1例患者皮瓣20小时内出现动脉危象,急诊手术探查,发现动脉吻合处形成血栓,遂改用前臂皮瓣来修复缺损,皮瓣存活。术区及受区均为Ⅰ期愈合,患者术后受区外形及功能恢复良好,供区愈合良好,下肢负重、行走正常。
结论：
股前外侧穿支皮瓣对供区的损伤软小,修复效果理想,有利于口腔颌面部外形及功能的恢复,是一种较理想的修复口腔颌面部软组织缺损的方法。但是手术操作较复杂,难度大于前臂皮瓣,对手术医生技术熟练程度要求较高。
Objective:
To investigate the method, effectiveness and clinical application of anterolateral thigh perforator free flaps transplantation for reconstruction of soft tissue defects of oral maxillofacial region.
Methods:
After general anaesthesia with trachea intubation, a two-team approach was used for resection of the tumor and harvest of the free flap simultaneously or successively. The oral maxillofacial surgeon removed the tumor, and stitched the flap with tissues around defects. And the hand surgeons harvested the flaps, and did microvascular anastomosis. Incision of the skin and subcutaneous tissue was carried out along the periphery of the flap, then divide and separate subcutaneous tissue layer from deep fascia layer little by little carefully and slowly to preserve one major perforating branches. Retrograde dissection and trace the major perforating branches through the deep fascia, muscle tissue, until length and diameter of pedicled blood vessels were enough for anastomosis with the blood vessels in the recipient sites. The incision of donor sites could be primary sutured. The surgeons sutured the edges between the flap and defects first, then anastomosed blood vessels with 8-0 nylon sutures under microscope. Healing condition was observed after operation. Meanwhile, whether skin flap had necrosis and wound was broken were observed at the same time, Clinical data was obtained from different ways, such as the reference of clinical records, telephone follow-up and return visit, preoperative and postoperative photographs.
Result:
4 perforator flaps survived completely.1 case failed, so he had an Emergency operation,and we found thrombus within stoma, and instead we use forearm flap to repair the defect, and succeeded. Primary wound healing was achieved(stage I)in all the donor sites and the recipient site. Appearance and function of oral is good. After wound healing, there was no significant scaring, and no effect on the lower limb weight bearing and walking.
Conclusion:
anterolateral thigh perforator free flap grafting is an acceptable technique for reconstruction of oral maxillofacial soft tissue defects. But the operation is more difficult than harvesting forearm flap, so it requires the surgeon have a high degree of operation.
引文
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