股前外侧皮瓣在口腔颌面外科的临床应用

发布时间：2019-04-09 06:29

【摘要】：目的:探讨应用血管化游离股前外侧皮瓣(free anterolateral thigh flap,ALTF)修复口腔颌面外科组织缺损的临床特点与治疗效果。方法:选择2011年1月至2013年2月间我科收治的39例因各种原因导致的颌面部缺损的患者,其中因口腔癌手术扩大切除后致缺损的患者35例,因面部巨大神经纤维瘤切除术后致缺损的患者1例,因外伤致颌面部软组织缺损的患者3例。术中均切取与受区大小相适应的皮瓣,部分皮瓣带有肌袖以填塞死腔,并将旋股动脉的降支与颌外动脉或甲状腺上动脉做端端吻合,将血管蒂部的伴行静脉与颈内静脉或颈外静脉做端侧吻合。观察移植后的皮瓣存活情况及受区功能重建的特点。结果:39例患者中36例皮瓣顺利成活,1例糖尿病患者术后15 h出现静脉血管危象,经积极抢救皮瓣仍全部坏死;2例患者术后10~15 h出现静脉危象,经抢救完全存活。术后随访6~30个月,平均9.7个月,受区皮瓣表面积无缩小,皮下脂肪1/3~1/2吸收,供区组织线性瘢痕,无明显畸形,腿部活动正常。结论:血管化游离ALTF具有切取简单易学、可塑性强、受区外形及功能满意、供区组织量丰富、血管位置恒定及血管蒂长、供区外形及功能影响小等优点,可广泛应用于口腔颌面外科组织缺损的修复重建。
[Abstract]:Objective: to investigate the clinical characteristics and therapeutic effect of vascularized free anterolateral femoral flap (free anterolateral thigh flap,ALTF) in the repair of oral and maxillofacial tissue defects. Methods: from January 2011 to February 2013, 39 patients with maxillofacial defects due to various causes were enrolled in our department. 35 of them were caused by extensive resection of oral cancer. One patient suffered from defect after resection of giant neurofibroma of the face, and three patients suffered from soft tissue defect of maxillofacial region caused by trauma. The flap with muscle cuff was used to fill the dead cavity, and the descending branch of the circumflex femoral artery was anastomosed to the external maxillary artery or the superior thyroid artery in an end-to-end manner, and the lower branch of the circumflex femoral artery was anastomosed end-to-end with the external maxillary artery or superior thyroid artery. End-to-side anastomosis was performed between the accompanying vein of the pedicle and the internal jugular vein or the external jugular vein. The survival of skin flap after transplantation and the characteristics of functional reconstruction of recipient region were observed. Results: of the 39 cases, 36 cases survived successfully, 1 case had venous vascular crisis 15 hours after operation, and 2 cases had venous crisis 10 hours after operation, and 2 cases survived completely after rescue. The postoperative follow-up period was 6-30 months (mean 9.7 months). The surface area of the recipient skin flap did not decrease, subcutaneous fat 1-3-1-2 absorption, the donor tissue linear scar, no obvious deformity, normal leg movement. Conclusion: vascularized free ALTF has the advantages of simple and easy to cut, strong plasticity, satisfactory shape and function of recipient region, abundant tissue quantity of donor area, constant position of blood vessel and long pedicle of blood vessel, and little influence on the shape and function of donor area. It can be widely used in the reconstruction of oral and maxillofacial surgery tissue defects.
【作者单位】：重庆医科大学附属第一医院口腔颌面外科;重庆医科大学现代教育技术中心;
【分类号】：R782.2

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