基于美容单位的自由式穿支皮瓣在面部肿瘤切除后缺损修复中的应用  

Clinical effect of using free-style perforator flap based on aesthetic units on facial reconstructionafter tumor resection

作　　者：余道江[1] 曹世坤 蔡卫超 孙卫[1] 韩文雅[1] 伍丽君[1] 于文渊[1] 庄卉如 赵天兰[1] Yu Daojiang;Cao Shikun;Cai Weichao;Sun Wei;Han Wenya;Wu Lijun;Yu Wen-yuan;Zhuang Huiru;Zhao Tianlan(Department of Plastic Surgery,Second Affiliated Hospital of Soochow University y Suzhou 215004,China)

机构地区：[1]苏州大学附属第二医院整形美容科,215004

出　　处：《中华整形外科杂志》2019年第11期1096-1101,共6页Chinese Journal of Plastic Surgery

基　　金：国家自然科学基金(81703157);江苏省青年医学重点人才(Q NRC2016860);苏州市科技指导计划(SYSD2015092)。

摘　　要：目的介绍一种基于美容单位的自由式穿支皮瓣在面部肿瘤切除后缺损修复中的应用。方法2013年12月至2017年1月苏州大学附属第二医院整形美容科收治72例面部肿瘤切除后缺损患者,男31例,女41例,年龄45-101岁。依据术前多普勒血流探测仪对创面周围穿支血管的探测信号,结合面部美容单位,不拘泥于传统的面部解剖学标志及解剖变异限制,更“自由”地设计以穿支血管为蒂的V・Y推进皮瓣、旋转皮瓣、螺旋桨皮瓣等多种形式皮瓣,修复创面。皮瓣最大面积12.0 cm x6.0 cm,最小面积1.5 cm x 1.0 cm,蒂部穿支血管直径0.3~3.0 mm,部分蒂部为穿支血管束。结果本组72例,68例一期愈合,术后外形良好;1例术后出血,皮瓣张力较大,切口愈合不良,予换药处理,2周后愈合;3例静脉回流不畅,皮瓣淤血,针刺放血处理后,延迟愈合。结论对于肿瘤扩大切除后面部缺损的修复,基于面部美容单位及术前多普勒探查的穿支血管设计自由式穿支皮瓣,是一种安全、可靠、多形的皮瓣,既可在皮瓣的选择方面提供更大的自由度,又可取得更好的美容效果。Objective To introduce the application of free-style perforator flap based on aestheticunits to repair facial defect after tumor resection. Methods By following the concept of free-style perforatorflap and the principle of facial aesthetic unit, the design of a free-style perforator flap allowed over anynearby cutaneous vessel chosen purely on the characteristics of its Doppler signal. Conventional knowledgeof anatomical landmarks and possible vascular variations were less relevant. A greater freedom in flapselection was gained to recover defect in different forms such as rotation flap, advanced flap and propellerflap,which were all based on free-style perforators. The flap size ranged from 1. 5 cmx 1.0 cm to 12. 0 cmx6. 0 cm with the perforator diameter of 0. 3-3. 0 mm in pedicle, and some of the pedicles are u perforatorclustersM. Results A total of 72 cases underwent surgery, and 68 cases survived completely withsatisfactory appearance. 1 case healed two weeks later through dressing due to undesired healing, whichresult ed from high tension secondary postoperative blooding. 3 cases healed in a delay due to congestionand gained acupuncture treat. Conclusions The free-style perforator flap, which depended on Dopplerdiscernedperforator and facial aesthetic unit, represents safe, reliable and versatile for repairing facialdefect after extended resection, and it not only offers a greater freedom in flap selection but also provides good aesthetic result.

关 键 词：面部肿瘤 修复 穿支皮瓣 美容单位 

分 类 号：R73[医药卫生—肿瘤]