耳前窄蒂侧颌颈皮瓣修复面部组织缺损临床探究.docVIP

耳前窄蒂侧颌颈皮瓣修复面部组织缺损临床探究[摘要］目的：探讨侧颌颈皮瓣的设计应用及其对面部组织缺损的修复方法。 方法：沿颌缘颏下方向切取耳前窄蒂侧颌颈皮瓣，修复面部组织缺损。皮瓣最大14cm×6.5cm，最小4.5cm×1.2cm，蒂部宽1.2～3.0cm，长2～5cm。 结果：应用侧颌颈皮瓣治疗9例，除1例皮瓣远端瓣尖处发生小范围坏死外，其余均全部成活。结论：运用侧颌颈皮瓣，可一次性修复面部较大面积的皮肤组织缺损，供区可直接闭合、无需植皮，位置隐蔽，外观形态佳。 [关键词]侧颌颈皮瓣；面部缺损；修复 [中图分类号]R622[文献标识码]A[文章编号]1008-6455（2007）09-1202-03 A clinical study of repairing of facial tissue defect with preauricular lateral maxillocervical fasciocutaneous flap DA Xiang-dong1,NING Jin-long2,ZHONG Li1,CAI Zhi-wen1 （1.Department of Plastic and Burns Surgery,Lujiang People’s Hospital,Hefei 231500,Anhui,China; 2.Department of Plastic Surgery,the First Affiliated Hospital of Anhui Medical University,Hefei 230022 China) Abstract:ObjectiveTo explore the design and repairing method of the reverse narrow pedicle lateral maxillocervical fasciocutaneous flap.MethodsFacial tissue defect was repaired by the flap along acrodont and submental direction .The size of the flaps ranged from 4.5cm×1.2cm to 14cm×6.5cm,the width of pedicle ranged from 1.2～3.0cm,2～5cm in length.ResultsThe fasciocutaneous flaps were used in 9 cases.All flaps were survived except 1 (top of the) flap showing distal skin necrosis.ConclusionApplication of the flap can repair large facial tissue defect at a time The donor site can be closed directly without transferring skin. It is inconspicuous and good appearance. Key words:maxillocervical fasciocutaneous flap; facial defect; repair 各种因素引发的面部皮肤及深层组织病变或缺损，临床很多见，亦有多种皮瓣可供修复，优缺点各异。自2002年5月以来，我们在赵天兰等［1］率先设计应用侧颌颈皮瓣修复面部创面的启示下，经改进设计应用该皮瓣修复面部组织缺损，共计9例，亦取得了较好的临床效果，现报道如下。 1手术方法 1.1 术前准备与设计： 除进行常规检查及相关专科检查外，术前应对病变部位活组织取样做病理检查，并依据其结果决定手术切除的范围。良性肿瘤距病变0.5cm设计切口线，恶性肿瘤则根据其恶性程度选取距病灶2～3cm标记切口线。再根据病变的部位、欲切除的范围，沿颌缘颏下方向设计大于缺损创面周缘0.5cm的侧颌颈皮瓣，蒂部位于耳前、含颞浅动脉及其向下的分支血管(血管彩超可做出明确定位)，并做好标记［2］。 1.2 手术操作： 采用局麻或局麻加基础麻醉，麻醉起效后沿标记线切除病变组织，若为恶性合并组织坏死感染病例，则在切至正常组织后再以蒸馏水或平阳霉素溶液反复冲洗、并以抗生素湿敷；沿设计线切开皮瓣远端的皮肤皮下组织直至深筋膜层，切开皮瓣的内外侧及上缘，自远向近保持在同一层次游离皮瓣，至蒂部时小心切开蒂部的内外侧至深筋膜，从深筋膜层游离蒂部（并留意皮瓣的血供）使整个皮瓣完全游离，创口彻底止血，观察皮瓣血运良好，经明道将皮瓣