摘要
目的对股前外侧组织瓣在口腔颌面部软组织缺损修复和颜面萎缩整复中应用的有关临床问题进行总结评价。方法对2007年9月～2009年10月第四军医大学第三附属医院口腔颌面外科11例应用股前外侧组织瓣修复颌面部软组织缺损及凹陷畸形的临床病例进行回顾性分析总结。针对不同组织缺损和畸形的具体情况,使用不同构成的组织瓣对其进行修复,其中股前外侧脂肪筋膜瓣进行性颜面萎缩症充填4例,股前外侧皮瓣同期或二期修复肿瘤术后软组织缺损7例;男性4例,女性7例;年龄16～58岁,平均33.5岁;组织瓣面积9cm×7cm～15cm×12cm;术后观察随访3个月～24个月,对皮瓣的颜色、质地、面部外形及功能恢复、供区的并发症及畸形进行总结分析。结果术后所有组织瓣均成活,有2例皮瓣尖端皮肤出现小范围液化坏死,有2例组织瓣发生血管危象经及时处理皮瓣成活;4例股前外侧脂肪筋膜瓣修复颜面萎缩术后3月内面部略显臃肿,其中有2例患者手术于后6～12月行二期整复后面形恢复效果满意;3例用于修复颧面部及颈部缺损的皮瓣均完全成活,颜色质地及厚度适宜,外形无臃肿;3例口底癌、舌癌术后缺损修复后语音及舌体运动尚可,张口度理想,皮瓣稍显臃肿。所有患者供区伤口均一期愈合,其中9例患者腿部供区未植皮直接缝合,2例患者由于供区面积过大行游离植皮修复。所有患者术后1月内供区下肢均出现肌肉无力感觉,3～6月后下肢负重、行走不受明显影响;供区瘢痕隐蔽,所有患者表示能够接受供区遗留手术后痕迹;供区远期无明显的并发症和畸形。结论股前外侧组织瓣游离移植具有供区组织量丰富,易成形,血管位置恒定且血管蒂长,皮瓣薄厚可根据缺损需要调整构成,供区较隐蔽,不损伤主要的血管和神经,对供区功能及外形影响小等优点,是修复口腔颌面部软组织缺损和畸形的理想皮瓣,值得进一步的推广和应用。
Objective To evaluate the effectiveness of anterolateral thigh flap in the repair of maxillofacial soft tissue defects and facial atrophy deformity. Methods A retrospective study on 11 cases (4 males and 7 females; age range: 16～58 years, average age: 33.5 years) with oral and maxillofacial soft tissue defects restored with free anterolateral thigh flap . Different flap designs were employed depended on the defects types. Among them,we applied free anterolateral thigh adipofascial flaps in 4 cases for reconstruction of facial depression were diagnosed hemifacial atrophy and free anterolateral thigh f1ap in 7 cases for defects of sofe tissue were caused by tumor ablation in the oral and maxillofacial. The area of the flaps ranged from 9cm×7cm～15cm×12cm . The appearance and function of the faciocervical organs and donor site complications and morbidities were evaluated after 3-24months'follow-up. Results All the 11 flaps survived after operation except there was a necrosis on the surface of the flap peak in 2 cases. The free anterolateral thigh adipofascial f1ap appeared obese and 2 patients received secondary period plastic operation of the flaps 6-12 months postoperatively. All the free thinning anterolateral thigh flap had goodelasticity and good appearance and no encumbrance. The flaps for reconstruction of oral cancer defects presented a satisfactory function and overstaffed slightly. All the donor sites were where dissected the flaps resulted in primary healing. The donor sites were performed primary skin closure in 11 cases and were given skin graft in 2 cases. No functional impairment at the donor sites occurred for the long-term effect. Conclusion Using free anterolateral thigh flap for reconstruction of soft tissue defect at oral and maxillofacial region can achieve relatively satisfactory results as it possesses the advantages of abundance volume,easily molding and adjusting the thickness,possessing long vascular pedicle,composition need to be adjusted according to defects, easily concealed donor site,no need to sacrifice neither major nerves nor major blood vessels,and little donor site complications and malformation. Therefore,using free anterolateral thigh flap is relatively an ideal measure for reconstruction of soft tissue defect and deformities at oral and maxillofacial region
引文
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