股前外侧free-style穿支皮瓣在口腔颌面部缺损修复重建中的应用  

Application of vascularized anterolateral thigh perforator flap harvested with free-style approach in oral and maxillofacial reconstruction

作　　者：陈洁[1] 蒋灿华[1] 尹乒[1] 杨龙[1] 吴晓珊[1] 黄龙[1] 翦新春[1] 

机构地区：[1]中南大学湘雅医院口腔颌面外科,长沙410008

出　　处：《中华显微外科杂志》2015年第1期20-24,共5页Chinese Journal of Microsurgery

摘　　要：目的 探讨股前外侧free-style穿支皮瓣的制备方法及其在口腔颌面部缺损修复重建中的应用价值. 方法 2013年8月-2014年5月,采用free-style手术方式制备股前外侧穿支皮瓣一期修复53例口腔颌面部肿瘤根治术后缺损.术前应用手持式声学多普勒标记股前外侧供区皮肤血管穿支,并以此为中心根据受区缺损的大小和范围设计相应形状的皮瓣.术中先通过内侧的皮瓣边缘切口于阔筋膜上暴露穿支,然后逆行解剖出足够长度的血管蒂,部分病例根据受区需要于显微镜下对皮瓣进行修薄处理. 结果 53例皮瓣均移植成功,5例因修薄出现表皮剥脱,4例边缘部分坏死经清创换药后愈合.术后随访5- 14个月,受区外形及语音、吞咽功能恢复较好.供区均一期关闭且无伤口裂开、切口瘢痕增生及远期下肢肌力下降等并发症发生. 结论 股前外侧free-style穿支皮瓣制备方法通过术前精确定位血管穿支能在最大限度保存供区美观、减少功能损害的同时达到理想的修复效果,符合现代修复重建外科微创、精细及个体化的理念.Objective To assess the harvest method and application value of free-style anterolateral thigh perforator flap （ALTPF） in oral-maxillofacial reconstruction.Methods Fifty-three patients who suffered from oral and maxillofacial tumor underwent simultaneous reconstruction using free-style ALTPFs after radical resection from August,2013 to May,2014.Perforators of the ALTPF region were marked through hand-held Doppler probe preoperatively.Flaps were designed centered on perforators according to the defect size of the accepting site.Incisions were first made at the inner border of the designed flap.Perforators were exposed above the fascia lata femoris and then dissected retrogradely through the vastus lateralis muscle to harvest a vascular pedicle with desired caliber and length.Flap thinning was applied under microscope in some cases to compromise the need of the accepting site.Results All 53 flaps survived after transplantation while skin exfoliation occurred in 5 cases due to flap thinning.Four cases sustained partial necrosis and was cured by trimming and dressing changes.Five to 14 months＇ post-operative followup showed satisfactory accepting-site morphology with good speech function and swallowing recovery.All donor sites were closed primarily without skin-grafting,leaving no donor-site complications including incision disruption,scar hyperplasia and muscle strength degeneration of the lower limb.Conclusion Multiple perforators have been accu rately located preoperatively in free-style harvest approach of ALTPFs,thus optimal effects can be reached with decreased donor-site morbidity and improved aesthetic outcome to the uttermost,which accords with the refined,personalized and minimal invasive development concept of modem reconstructive surgery.

关 键 词：股前外侧皮瓣 穿支皮瓣 自由式 口腔颌面部 显微外科手术 

分 类 号：R782.2[医药卫生—口腔医学]