局部穿支蒂推进皮瓣修复面中部软组织缺损与面中部皮韧带三维构筑的相关性研究  

Correlation between the local perforator advancement flap for mid-face defects and the three-dimensional configuration of the skin ligament

作　　者：李心怡[1] 张铭[2] 张伟[1] 宁金龙[1] 朱飞[1] 王邦河[1] 席庆春 李小静[1] Li Xinyi;Zhang Ming;Zhang Wei;Ning Jinlong;Zhu Fei;Wang Banghe;Xi Qingchun;Li Xiaojing(Department of Plastic Surgery,the First Affiliated Hospital of Anhui Medical University,Hefei 230032,China;Department of Anatomy,University of Otago,Dunedin 9016,New Zealand;Department of Plastic Surgery,Hefei Second People’s Hospital,Hefei 230041,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]新西兰奥塔哥大学解剖学系,达尼丁9016 [3]合肥市第二人民医院整形外科,合肥230041

出　　处：《中华整形外科杂志》2022年第10期1094-1101,共8页Chinese Journal of Plastic Surgery

基　　金：合肥市自主创新政策"借转补"项目(J2020Y02)。

摘　　要：目的探讨局部穿支蒂推进皮瓣修复面中部软组织缺损的临床效果及其与面中部皮韧带三维构筑的相关性。方法 (1)选用新鲜成人尸体标本12具(男7例, 女5例, 年龄54~87岁), 尸体头部经丙酮脱水、脱脂后, 以环氧树脂全透明超薄层进行塑化与切片, 使用Leica MZ8立体显微镜和Leica DFC295数码相机观察、分析制备的切片, 观察面中部不同局部(面颊部、鼻部、眶睑部)的皮韧带三维构筑特点的差异。(2)回顾性分析安徽医科大学第一附属医院整形外科2015年1月至2021年10月收治的面中部软组织缺损病例资料, 患者均采用局部穿支蒂推进皮瓣修复缺损。应用Pearson双变量相关性检验分析皮瓣推进距离、皮瓣切取面积、皮瓣长宽比、缺损面积间的相关关系, 应用Kruskal-Wallis检验分析面中部不同部位皮瓣面积、皮瓣长宽比等的差异性。计量资料以±s或M(Q_(1), Q_(3))表示。结果 (1)解剖学研究显示, 面部皮韧带走行方向与表情肌走行方向一致, 其在上眼睑和上鼻翼鼻面角处的三维构筑具有差异性, 上眼睑皮韧带顺眼睑方向走行, 而上鼻翼处皮韧带朝鼻翼下方走行。(2)临床研究纳入18例患者, 男8例, 女10例, 年龄(64.6±23.4)岁。术后18例患者皮瓣均存活, 皮瓣面积为10.6(8.0, 18.0) cm2, 推进距离为2.8(2.0, 4.0) cm。统计学分析显示, 皮瓣推进距离与皮瓣切取面积(r=-0.71, P=0.022)和皮瓣长宽比(r=-0.58, P=0.012)均存在相关性, 皮瓣长宽比与缺损面积无相关性(r=-0.23, P=0.365);面颊部、鼻部、眶睑部皮瓣的长宽比分别为2.1(1.9, 2.3)、2.0(1.6, 3.5)、3.5(3.0, 4.0), 差异有统计学意义(H=6.59, P=0.037)。结论局部穿支蒂推进皮瓣是修复面中部软组织缺损较为理想的方法。面中部不同部位的皮韧带构筑的差异会影响各部位皮瓣推进的难易程度等特性, 可能是影响皮瓣设计时长宽比等的原因。Objective To investigate the clinical effect of local perforator advancement flap in repairing mid-face soft tissue defects and its correlation with the three-dimensional configuration of the skin ligament.Methods(1)Tweleve fresh adult cadaver specimens,including seven males and five females,aged 54-87 years old,were selected.After dehydration and degreasing of the cadaver head with acetone,plasticized and sliced with a fully transparent ultra-thin layer of epoxy resin,using a Leica MZ8 stereo microscope and a Leica DFC295 digital camera to observe and analyze the prepared slices and observe the differences in the three-dimensional structural characteristics of the cutaneous ligaments in different parts of the mid-face(cheek,nose,orbital eyelid).(2)A retrospective study was conducted with the data of mid-face soft tissue defects admitted to the Department of Plastic Surgery of the First Affiliated Hospital of Anhui Medical University from January 2015 to October 2021.All patients were repaired with local perforator advancement flaps.The Pearson bivariate correlation test was used to analyze the correlation among flap advancement distance,flap area,flap aspect ratio,and defect size.The Kruskal-Wallis test was used to analyze the differences in flap size and aspect ratio in different parts of the mid-face.The measurement data were described by Mean±SD or M(Q1,Q3).Results(1)Anatomical studies have shown that the running direction of the facial skin ligaments is the same as that of the expressive muscles,and their three-dimensional structures at the upper eyelid and the nasal and facial corners of the upper nasal alar are different.The upper eyelid skin ligaments run along the eyelid,while the upper nasal cutaneous ligaments run down the nose alar.(2)The clinical study included 18 patients,including eight males and ten females,aged(64.6±23.4)years old.All flaps survived uneventfully.The average flap size was 10.6(8.0,18.0)cm2,and the average advancing distance was 2.8(2.0,4.0)cm.Statistical analysis showed a correl

关 键 词：面部损伤 面部肿瘤 穿支皮瓣 推进皮瓣 皮韧带 相关性研究 

分 类 号：R622[医药卫生—整形外科]