同种异体头皮、面颈部和双耳郭复合组织移植术外科技术探讨的回顾  

Discussion of techniques for allograft transplantation with compound tissue of two ears and skin of head and neck

作　　者：姜会庆[1] 李幼生[2] 汪涌[1] 胡心宝[1] 汪军[1] 孙东燕[1] 陈一飞[1] 黎介寿[2] 

机构地区：[1]南京军区南京总医院烧伤整形科,江苏南京210002 [2]南京军区南京总医院普通外科研究所,江苏南京210002

出　　处：《中国实用美容整形外科杂志》2005年第4期211-213,共3页

摘　　要：目的探讨全头皮、面颈部和双耳郭复合组织移植术的外科技术操作问题.方法供体选自血型相配的脑死亡患者.切取层次,头顶部于骨膜或帽状筋膜层间;双侧颞部于颞深筋膜浅层;面部为紧贴颧骨、下颌骨切取,包括咀嚼肌和耳郭;颈部包括胸锁乳突肌、颈外动脉、颈外静脉.同时自左右侧颈总动脉灌注4 ℃UW液.供体经修整与X线照射后,保存于0～4 ℃ UW液中,备用.结果移植的头皮瓣及双侧耳郭血循环良好,皮肤色泽正常、温热.创面Ⅰ期愈合,头发生长良好,无明显脱发.术后4个月移植物取检无排斥反应.结论经外科技术及术后抗排斥处理的结果发现,同种异体头皮瓣及双耳、面颈复合组织移植术是可行的.但目前手术适应证尚处于个案选择,如何推广应用,简化应用抗排斥药物,以减少全身不良反应,将是进一步研究的重要课题.Objective To investigate the possibility and efficacy of aUograft transplantation in treating patient with huge tissue defect after radical giant malignant melanoma resection. Methods A male person received blood type matching was chosen as donor. Immediately after the donor＇s brain death, allograft was excised with the depth to the layer intervenient between periosteum and epicranial fascia in calvaria, the superficial layer of deep temporal fascia in both sides of temporal regions, close to zygomatic bones and mandibles including masseter and auricles upon in face, and cervical soft tissues including sternocleidomastoid muscles, cervical and external jugular vessels of both sides were excised simultaneously. After being perfused with 4 ＊C UW solution through both common carotid arteries, the homograft was sheared and radiated with X-ray before being preserved in UW solution for further use. Results The circulation of the graft was satisfactory, and the temperature and color of skin were normal. Primary healing of suture and hair growth about 0.8 cm in a month were observed. Hyperacute or acute rejection was not found in skin biopsies on every time. Conclusion Allograft transplantation with compound tissue of head and neck skin flap and ears is a kind of effective and safe treatment in repairing huge tissue defect. But at present, Evaluating indications of this techniques only used in individual case. How to improve and apply the techniques and how to simplify use the antirejective drugs with few systemic toxins will be the further discussing objects.

关 键 词：同种异体移植 头皮瓣 颈部软组织 耳郭 

分 类 号：R622[医药卫生—整形外科]