多源性供血的角形穿支皮瓣修复颜面部大面积软组织缺损  

Application of the horn-shaped perforator flap with multiple blood supply for reconstructing the massive facial defect

作　　者：郭冰灿 李小静[1] 宁金龙[1] 李心怡[1] 李茜 翁晓娟 高明珠[1] Guo Bingcan;Li Xiaojing;Ning Jinlong;Li Xinyi;Li Xi;Weng Xiaojuan;Gao Mingzhu(Department of Plastic Surgery,First Affiliated Hospital of Anhui Medical University,Hefei 230022,China;Department of Plastic and Aesthetic Surgery,Yuyan Medical Cosmetology Hospital of Hefei,Hefei 230088,China)

机构地区：[1]安徽医科大学第一附属医院整形外科,合肥230022 [2]合肥玉颜医疗美容医院整形美容外科,合肥230088

出　　处：《中华整形外科杂志》2022年第7期792-797,共6页Chinese Journal of Plastic Surgery

基　　金：2020年合肥市自主创新政策"借转补"项目(J2020Y02)。

摘　　要：目的探讨应用多源性供血的角形穿支皮瓣修复各种原因所致颜面部大面积软组织缺损的方法及临床效果。方法选择2015年6月至2020年7月安徽医科大学第一附属医院整形外科收治的颜面部大面积缺损患者,术前使用多普勒超声血流探测仪测定并标记颜面部主干源血管区域及穿支浅出点的位置;术中根据创面大小、周围皮肤松弛度,以及创面远端至所选择的穿支皮瓣蒂的距离,并参考郎格氏线,设计多源性供血的角形穿支皮瓣,角形穿支皮瓣头端约等于缺损宽度、长约为缺损宽度的3.0~3.5倍。切开皮瓣远端,紧贴浅表肌腱膜系统浅层,由近及远锐、钝性分离,形成较大的穿支蒂皮瓣,保留皮下穿支周围少量纤维组织蒂,将皮瓣旋转推进无张力覆盖、修复受区缺损创面,供区可直接拉拢缝合或稍作松解后闭合。术后随访,观察创面愈合情况、瘢痕情况及有无相关恶性肿瘤的复发及转移。结果共选择9例颜面部大面积缺损患者,男4例,女5例,年龄35~81岁,平均58岁。皮瓣面积10.0 cm×6.0 cm~14.0 cm×7.0 cm。9例患者皮瓣均存活,切口一期愈合。经3~24个月随访,未见癌肿复发、明显瘢痕、皮瓣臃肿或后遗面部畸形等并发症,美学亚单位结构及功能满意。结论多源性供血的角形穿支皮瓣用于修复颜面部大面积软组织缺损,设计简单、切取方便、血运丰富,色泽、质地与周围皮肤一致,切口瘢痕多可隐藏在自然郎格氏线中,形态和功能满意,尤其适用于面部皮肤松弛的中老年患者。Objective To investigate the method and clinical effect of horn-shaped perforator flaps with multiple blood supply for reconstructing massive facial defects caused by various reasons.Methods A retrospective review was performed on patients with massive facial defects in the Department of Plastic Surgery of First Affiliated Hospital of Anhui Medical University from June 2015 to July 2020.The Doppler ultrasound was used to localize the facial source artery and perforators preoperatively.During the operation,the flap was designed according to the defect size,the elasticity of around skin,the length from the distal end of the defect to the location of the selected perforator,and the Langer’s line of the face.The length of the proximal part of the flap was approximately equal to the defect width,and the length of the flap was about 3 to 3.5 times longer than the defect width.An incision was made along the distal part of the flap.The flap dissection proceeded in a proximal to distal fashion superficial to the superficial musculoaponeurotic system,until forming a large perforator flap.A small number of fibrous around the perforator were retained,and the flap was rotated and advanced to reconstruct the defect without any tension.The donor site was closed directly.Wound healing,scar formation,tumor recurrence,and tumor metastasis were followed postoperatively.Results A total of nine cases were enrolled,with four male patients and five female patients.The mean age of the patients was 58 years,ranging from 35 to 81 years.The size of the flap ranged from 10.0 cm×6.0 cm to 14.0 cm×7.0 cm.All flaps survived,and the wound healed primarily.After 3 to 24 months of follow-up,no recurrence of tumor,obvious scar,flap bloated,facial deformity,or other complications were observed.The patients was satisfied with the aesthetic subunit structure and function.Conclusions The horn-shaped perforator flap with multiple blood supply is simple in design,easy in decision,reliable in blood supply,and consistent in color and texture with the

关 键 词：外科皮瓣 穿支皮瓣 面部缺损 修复 

分 类 号：R622[医药卫生—整形外科]