带穿支腹外斜肌岛的髂骨瓣重建下颌骨的改良术式初探  

Mandibular Reconstruction Using Iliac Bone Flap with Perforator based External Oblique Abdominal Muscle:A Pilot Study

作　　者：张于涵 史敬存 吴梓谦 张冰清 张士剑 肖孟 王磊[1,2] ZHANG Yuhan;SHI Jingcun;WU Ziqian;ZHANG Bingqing;ZHANG Shijian;XIAO Meng;WANG Lei(Department of Oromaxillofacial Head and Neck Oncology,Shanghai Ninth Peoples’s Hospital,Shanghai Jiao Tong University School of Medicine,College of Stomatology,Shanghai Jiao Tong University,National Center for Stomatology,ational Clinical Research Center for Oral Diseases,Shanghai Key Laboratory of Stomatology,Shanghai 200011,China;Department of Oromaxillofacial Head and Neck Oncology,Fengcheng Hospital(Shanghai Ninth People's Hospital Group),Shanghai 201411,China.)

机构地区：[1]上海交通大学医学院附属第九人民医院口腔颌面-头颈肿瘤科,上海交通大学口腔医学院,国家口腔医学中心,国家口腔疾病临床医学研究中心,上海市口腔医学重点实验室,上海市口腔医学研究所,上海200011 [2]上海市奉贤区奉城医院(上海第九人民医院集团)口腔颌面-头颈肿瘤科,上海201411

出　　处：《口腔医学研究》2023年第7期640-643,共4页Journal of Oral Science Research

基　　金：国家自然科学基金(编号:81970907、81771046);上海交通大学医学院附属第九人民医院临床助推项目(编号:JYLJ201817)。

摘　　要：目的:在传统血管化髂骨瓣基础上,探索设计带穿支的腹外斜肌岛的改良术式,以便可靠地监测术后血供并灵活修复周围软组织缺损。方法:选取因肿瘤或骨髓炎需节段性切除并重建下颌骨的4例患者,在获取传统髂骨瓣的同时,沿着旋髂深动脉(DCIA)找到其上升支并解剖部分腹外斜肌作为观察岛,将DCIA及伴行静脉常规吻合于颈部供区血管,并以钛板固定移植骨块。将游离的腹外斜肌放置在颌下皮肤外作为一个观察岛,通过观察其血供情况密切监测髂骨瓣。结果:4例患者手术均获成功。术后监测观察岛颜色、形态、质地便利,可以可靠地判断DCIA的血供良好。结论:带穿支的腹外斜肌岛的髂骨瓣改良新术式,既能可靠监测术后血供,又有灵活修复软组织缺损的潜力,值得进一步评估推广。Objective:To design an improved iliac bone flap with perforator based external oblique abdominal muscle(EOAM)island for monitoring postoperative blood supply and flexible repair of soft tissue defects based on the traditional vascularized iliac flap.Methods:Four patients who required segmental resection and mandibular reconstruction due to tumor or osteomyelitis were selected,the ascending branch was found along the deep circumflex iliac artery(DCIA)and a portion of the external abdominal oblique muscle was dissected as an observation island while harvesting the iliac flap,the DCIA and accompanying veins were routinely anastomosed,followed by fixation using a titanium plate.The free external oblique abdominal muscle was placed outside the submandibular skin as an observation island,and the blood supply of the iliac flap was closely monitored by the blood supply of the observation island.Results:The iliac flap was successful in all four patients.Postoperative monitor of the color,shape,and texture of the observation island allowed judging the blood supply of the DCIA.Conclusion:The improved iliac flap with a perforated EOAM island is worthy of further evaluation and promotion for both reliable monitoring of postoperative blood supply and flexible repair of soft tissue defects.

关 键 词：皮瓣监测 髂骨瓣 观察岛 血供 

分 类 号：R782.4[医药卫生—口腔医学]