【摘要】：目的:探討應(yīng)用血管化游離股前外側(cè)皮瓣(free anterolateral thigh flap,ALTF)修復(fù)口腔頜面外科組織缺損的臨床特點與治療效果。方法:選擇2011年1月至2013年2月間我科收治的39例因各種原因?qū)е碌念M面部缺損的患者,其中因口腔癌手術(shù)擴大切除后致缺損的患者35例,因面部巨大神經(jīng)纖維瘤切除術(shù)后致缺損的患者1例,因外傷致頜面部軟組織缺損的患者3例。術(shù)中均切取與受區(qū)大小相適應(yīng)的皮瓣,部分皮瓣帶有肌袖以填塞死腔,并將旋股動脈的降支與頜外動脈或甲狀腺上動脈做端端吻合,將血管蒂部的伴行靜脈與頸內(nèi)靜脈或頸外靜脈做端側(cè)吻合。觀察移植后的皮瓣存活情況及受區(qū)功能重建的特點。結(jié)果:39例患者中36例皮瓣順利成活,1例糖尿病患者術(shù)后15 h出現(xiàn)靜脈血管危象,經(jīng)積極搶救皮瓣仍全部壞死;2例患者術(shù)后10~15 h出現(xiàn)靜脈危象,經(jīng)搶救完全存活。術(shù)后隨訪6~30個月,平均9.7個月,受區(qū)皮瓣表面積無縮小,皮下脂肪1/3~1/2吸收,供區(qū)組織線性瘢痕,無明顯畸形,腿部活動正常。結(jié)論:血管化游離ALTF具有切取簡單易學(xué)、可塑性強、受區(qū)外形及功能滿意、供區(qū)組織量豐富、血管位置恒定及血管蒂長、供區(qū)外形及功能影響小等優(yōu)點,可廣泛應(yīng)用于口腔頜面外科組織缺損的修復(fù)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.
【作者單位】： 重慶醫(yī)科大學(xué)附屬第一醫(yī)院口腔頜面外科;重慶醫(yī)科大學(xué)現(xiàn)代教育技術(shù)中心;
【分類號】：R782.2

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