游离肋骨-前锯肌-皮肤复合组织瓣修复大面积颅骨缺损.doc

游离肋骨-前锯肌-皮肤复合组织瓣修复大面积颅骨缺损[摘要]目的：探讨吻合血管的游离肋骨-前锯肌-皮肤复合组织瓣修复大面积颅骨缺损的临床应用价值。方法：设计以胸背血管为营养血供的游离肋骨-前锯肌-皮肤复合组织瓣，用以修复大面积颅骨缺损10例。结果：10例患者，组织瓣完全成活9例，坏死1例。随访1～10年，患者术后外观满意，无感染、皮下积液等并发症发生。结论：游离肋骨-前锯肌-皮肤复合组织瓣可以很好地完成大面积颅骨缺损的修复，是一种理想的自体修复材料。 [关键词]颅骨缺损；颅骨成形；肋骨-前锯肌-皮肤复合组织瓣；显微外科 [中图分类号]R622 [文献标识码]A [文章编号]1008-6455（2012）01-0009-03 Reconstruction of large skull defect using rib-anterior serratus muscle-skin composite flap SHU Chang,TAO Ying-xue,ZHU Jun,FU Ai-jun,LI Jian-min,TAO zhi-lu （1. Department of Plastic Surgery,The Affiliated Hospital of Hebei United University,Tangshan 063000,Hebei,China; 2. Editorial Office of Publishing Management Center of Hebei United University;3. Department of Neurosurgery,The Affiliated Hospital of Hebei United University） Abstract: Objective To investigate the application of rib-anterior serratus muscle-skin composite flap in reconstruction of large skull defect. Methods Ten cases of large skull defect were repaired using revascalarized rib-anterior serratus muscle-skin composite flap,which blood supply was chest-ridge blood vessels. Results The composite tissue flap survived with primary healing in 9 cases,while necrosis occurred at one case. From 1 to 10 years follow-up, the postoperative appearance was satisfactory,and no complications such as infection and subscalp hydrops were found. Conclusions The free rib-anterior serratus muscle-skin composite flap is an ideal autogenous repair material,which can be best used in reconstruction of large skull defect. Key words:skull defect;cranioplasty;rib-anterior serratus muscle-skin composite flap; microsurgery 因外伤、肿瘤、颅内疾病等原因去骨瓣减压所致的大面积颅骨缺损临床上很常见。其修复在颅颌面外科中仍是一个具有挑战性的难题。1983～2010年，我院应用吻合血管的肋骨-前锯肌-皮肤复合组织瓣修复大面积颅骨缺损10例，取得了良好效果。 1 资料和方法 1.1 临床资料：本组10例，均为男性，年龄19～35岁，颅骨最大缺损面积12cm×14cm，最小8cm×8cm。致伤原因：交通事故5例，工矿外伤4例。木棒击伤1例。颅骨缺损部位：颞部8例；颞顶部1例；颞顶额1例。单侧颅骨缺损8例，双侧缺损2例。伤后距颅骨成形时间：3个月～10年。 1.2 手术方法：手术分胸部组和头部组，同时进行。 1.2.1 胸部组：按颅骨缺损面积，切取带血管蒂游离肋骨前锯肌皮瓣。 切口设计：先在腋前线确定第6 肋骨的位置, 再根据颅骨缺损的面积, 确定所需含