应用预构技术重建毁损脸面的12年经验总结  

Reconstruction of facial disfigurement with flap prefabrication technique： a 12-year experience

作　　者：昝涛 李海洲 顾斌 刘凯[1] 谢峰 谢芸 魏娴 高雅姗 黄昕 李青峰 Zan Tao;Li Haizhou;Gu Bin;Liu Kai;Xie Feng;Xie Yun;Wei Xian;Gao Yashan;Huang Xin;Li Qingfeng(Department of Plastic and Reconstructive Surgery,Shanghai Ninth People＇s Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200011,China)

机构地区：[1]交通大学医学院附属第九人民医院整复外科,上海200011

出　　处：《中华整形外科杂志》2018年第7期503-509,共7页Chinese Journal of Plastic Surgery

基　　金：国家自然科学基金（81772086）;上海市教育委员会高峰高原学科建设计划;国家科技支撑计划（2012BAIllBOO）

摘　　要：目的总结应用扩张预构皮瓣技术重建毁损脸面的临床经验。方法2005年9月至2016年6月，应用自体组织全脸面预构重建技术治疗面部Ⅲ-Ⅳ型缺损49例。一期治疗，获取旋股外侧血管降支联合肌间隔筋膜瓣，将其植人颈胸部皮下，与面动静脉或甲状腺上动静脉吻合，构建前胸区预构皮瓣，同期植入皮肤软组织扩张器。二期治疗，针对部分不耐受扩张的患者，采用皮瓣内干细胞移植治疗，实现皮瓣的超量扩张。三期治疗，以预构血管为蒂，移植预构脸面，术前针对可能出现转移后血运障碍的皮瓣进行外科延迟，术中使用吲哚菁绿血管造影技术评估皮瓣的血运情况，决定是否采用第2或第3乳内动脉穿支或胸外侧动脉穿支进行血管增压。后期修整，以凸显面部轮廓与五官的精细结构。采用A＆F评价法对每位患者修复前后面部的形态轮廓和功能进行评价。结果本组49例严重面部毁损病例，5例接受了干细胞注射治疗。扩张容量达2530—3500ml，皮瓣面积23em×18om-34em×32cm，25例选用血管增压。术后1例发生了5cmx2cm的坏死，4例尖端坏死，其余皮瓣成活。经A＆F标准评估，49例患者面部形态（1．15比2．29）和功能（0．86比2．42）得到了明显改善，差异有统计学意义（P〈0．01），面部微笑、眨眼和皱眉等表情得以体现。结论自体全脸面预构重建技术可以获得较为满意的面部形态和功能的恢复，有较好的安全性和有效性，适用于绝大多数全脸面毁损的患者。[Abstract] Objective To summarize clinical experience on reconstruction of severe facial disfigurement with flap prefabrication and soft tissue expansion. Methods From September 2005 to June 2016, 49 patients with type m and type IV facial deformities underwent facial reconstruction with an integrated method on the basis of prefabricated flaps. In the first stage, the descending branch of the lateral femoral circumflex vessels and the surrounding muscle fascia were dissected and transferred to subcutaneous pocket in the cervicothoracic area. The pedicles of the fascial flap were anastomosed to either the facial or superior thyroid artery and their venae comitantes in flap prefabrication. A tissue expander was placed beneath the fascial flap. In the second stage, over-expansion was achieved with intra-flap stem cell transplantation once patient＇s skin showed signs of intolerance to expansion. In the third stage, prefabricated flap was transferred to cover the facial defects, the second or third internal mammary artery perforators or lateral thoracic artery perforators were reserved and flap supercharging would be performed depending on the perfusion of the flap revealed by indocyanine green angiography intra-operatively. Later, flap revisions further restored facial outline and delicate organ configuration. Aesthetic and functional status were independently graded to assess the facial appearance and function before and after the reconstruction. Results 49 patients with severe facial deformities were included. 5 patients received stem cell transplantation. The final inflated volume ranged from 2 530 ml to 3500 ml and each patient had facial reconstruction with a prefabricated flap （range 23 cm ×18 cm - 34 cm ×32 cm）. Flap supercharging technique were used in 25 cases to augment blood perfusion, however, flap necrosis （5 cm ×2 cm） occurred in 1 patient, and tip necrosis occurred in 4 patients, otherwise, all flaps survived entirely. The aesthetic （1.15 to 2.29） and functional （0. 86 to 2.42） sta

关 键 词：面部 软组织扩张术 干细胞 预构皮瓣 预置皮瓣 

分 类 号：R622[医药卫生—整形外科]