旋髂深动脉穿支嵌合髂骨皮瓣修复下颌骨复合性缺损

发布时间：2018-06-15 07:06

  本文选题：旋髂深动脉 + 穿支嵌合皮瓣　； 参考：《华西口腔医学杂志》2015年03期

【摘要】：目的探讨旋髂深动脉穿支嵌合髂骨皮瓣(DCIAPF)在下颌骨复合性缺损重建中的应用价值与优缺点。方法 2014年3—7月应用DCIAPF游离移植一期修复6例下颌骨及软组织复合缺损患者。根据术前定位的旋髂深动脉皮肤穿支设计并逆行切取皮岛,随后于腹股沟区顺行解剖血管蒂并切取髂骨瓣,继续解剖旋髂深血管直至终末段与皮岛相续。完成DCIAPF切取后供区分层严密关闭以预防腹疝。结果 6例患者所制备的髂骨瓣长5.0~11.0 cm,皮岛3.5 cm×5.0 cm~7.0 cm×10.0 cm,供区均一期关闭未行植皮。1例皮岛穿支来自旋髂浅血管需另行吻合,其余5例成功制备为DCIAPF。移植的髂骨皮瓣均成活,仅1例因行皮岛修薄处理出现表皮剥脱和少量边缘坏死,经修剪及换药处理后愈合。术后随访3~6个月,牙槽嵴高度恢复满意,供区均未出现明显并发症。结论 DCIAPF血运丰富可靠,能提供足够的骨量供下颌骨重建并恢复牙槽嵴高度,为后期义齿修复创造有利条件;其皮肤穿支解剖较为恒定,携带皮岛组织量大,摆放灵活,供区隐蔽,是下颌骨复合性缺损修复重建的有效方法。
[Abstract]:Objective to evaluate the clinical value, advantages and disadvantages of DCIAPF in reconstruction of mandibular complex defect. Methods from March to July 2014, DCIAPF free graft was used to repair 6 cases of mandibular and soft tissue composite defects. According to the skin perforating branch of deep circumflex iliac artery located before operation, the skin island was removed retrograde, then the pedicle was dissected in the inguinal region and the iliac bone flap was removed, and the deep circumflex iliac artery continued to be dissected until the end of the circumflex iliac artery continued with the skin island. After DCIAPF removal, the differentiation layer is closed closely to prevent abdominal hernia. Results the iliac bone flap of 6 patients was 5.0 ~ 11.0 cm long and the skin island was 3.5 cm 脳 5.0 cm~7.0 cm 脳 10.0 cm. The perforating branches of the iliac circumflex artery from the superficial circumflex iliac vessels were all closed in one stage. The other 5 cases were successfully prepared as DCIAPF. All the iliac flap survived, only one case had epidermis exfoliation and a little edge necrosis due to the thinning of the skin island, and healed after pruning and dressing changing. After 3 ~ 6 months follow-up, the alveolar ridge height recovered satisfactorily, and no obvious complications occurred in the donor area. Conclusion DCIAPF can provide sufficient bone mass for mandibular reconstruction and restoration of alveolar ridge height, and create favorable conditions for restoration of denture in later stage. Concealment of donor area is an effective method for reconstruction of compound mandibular defect.
【作者单位】： 中南大学湘雅医院口腔颌面外科;
【分类号】：R782.2
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本文编号：2021150