股外侧筋膜及前臂游离带蒂皮瓣联合即刻修复下唇全层缺损临床研究.docVIP

股外侧筋膜及前臂游离带蒂皮瓣联合即刻修复下唇全层缺损临床研究 　　[摘要]目的：探讨前臂游离带蒂血管皮瓣及股外侧筋膜组织联合应用即刻修复下唇部软组织全层缺损的临床效果。方法：对因外伤后的下唇部软组织全层缺损的创面用前臂桡侧游离皮瓣及股外侧筋膜联合修复13例，应用显微外科技术将桡动脉与面动脉吻合，头静脉与颈外静脉吻合。结果：联合即刻修复下唇部各类全层软组织缺损13例，全部存活；1例皮瓣远端少许坏死，经换药治疗后完全愈合。术后随访1～36个月，成活的皮瓣质地优良，与基底附着良好，外观比较满意，未见塌陷下垂，功能及口角恢复良好。结论：股外侧筋膜及前臂游离带蒂皮瓣联合即刻修复下唇全层缺损（尤其双侧口角缺损），对外观修复及功能恢复优越于其他治疗方法。 　　[关键词]即刻修复；下唇全层缺损；股外侧筋膜；前臂游离带蒂皮瓣 　　[中图分类号]R782 [文献标志码]A [文章编号]1008-6455（2015）17-0021-03 　　Abstract： Objective To investigate the clinical application of forearm free flap and lateral thigh fascia in the reconstruction whole lower lip defect. Methods Combination of forearm free flap and lateral thigh fascia were used in 13 patients to reconstruct the whole lower lip defect which was caused by trauma.Microsurgery techniques was applied to vascular anastomosis，radial artery anastomized to facial artery and cephalic vein to external jugular vein. Results 13 patients with lower soft tissue defects were reconstructed with forearm arm free flap combination with lateral thigh fascia，and flaps were alive without severe complication.Only one flap showed mild distal part necrosis，and healed completely.All patients were followed up for 1-36 months，the flaps presented good quality and attachment.Patients were well satisfied with the appearance and function. Conclusion Vastus lateralis fascia and forearm free joint immediate pedicle flap to repair lower lip full-thickness defects， the appearance of repair and functional recovery is superior to other treatments. 　　Key words：linical application；lower lip defect；lateral thigh fascia；forearm free flap 　　唇是面部最重要的器官之一。唇组织的缺损不仅严重影响患者面容，而且会导致患者进食障碍、涎液外漏、语言不清、表情怪异等，严重影响患者的生理和心理健康。下唇组织缺损常见于外伤，其次多见于肿瘤。下唇部是人体面下1/3重要组成部分，大面积缺损即可修复，可恢复其外形及功能。我科自2008-2015年收治了不同程度唇缺损的患者共13例，采用了股外侧筋膜及前臂游离带蒂皮瓣联合手术方法来修复，取得了比较满意的修复效果，现报道如下。 　　1 资料和方法 　　1.1 临床资料 　　回顾性分析外伤致下唇部各类软组织缺损13例（男8例，女5例），年龄27～51岁。下唇部缺损创面：面积4.0cm×5.5cm～8.0cm×11.5cm，创面仅存极少量的软组织，面部畸形严重，包括特殊类型的双侧口角缺损患者（见图1）。 　　1.2 修复方法 　　1.2.1 传统方法：缺损相对较大（缺损接近2/3）的患者，则通过改良的Bernard瓣修