预制皮瓣在口腔颌面部缺损修复中的应用

Application of prefabricated flaps for reconstruction of oral and maxillofacial defects

预制皮瓣就是根据缺损整复的需要,将血管束预先转移到皮瓣内使皮瓣获得血管化后再带蒂转移或游离移植;或将骨和一些组织(如皮肤、筋膜、黏膜等)或人工材料预先转移到组织瓣内或组织瓣的筋膜面,进行“雕塑”制成具有三维立体结构的复合组织瓣,形成预构“器官”,待血循环建立后再以显微外科手段或带蒂方式将组织瓣转移到缺损区进行缺损的修复重建。口腔颌面部器官的形态复杂,如耳、鼻、唇等不仅外形不规则,而且具有三维立体结构。当上述器官缺如或缺损时,不论使用何种传统皮瓣,重建后的外形均不尽人意。由于预构皮瓣是在转移修复前将所需组织转移到血管区或将血管束转移到所需组织下,使临床医生有充裕的时间和空间模仿器官外形进行几何设计和外科制备,使得所预先构建的“器官”形态逼真。此种技术的应用,将极大改观口腔颌面部器官缺损修复重建的外观,达到一定美容效果,有效提高器官缺损患者的生存质量。

Flap prefabrication is a surgical procedure involving the introduction of a new blood supply by means of a vascular pedicle transfer into a volume of tissue or a technique in which special additional tissue （skin, mucous membrane or bone） is added to an existing flap to make a multilayered flap that may be used for complex, three-dimensional multilayered reconstructions. After a period of neovascularization, this prefabricated flap may be locally transferred, based only on its implanted vascular pedicle or distantly transferred by microsurgical technique. Organs in maxillofacial regions such as ear, nose and lip have complicated morphology and irregular contour and acceptable appearance is hard to be achieved after being reconstructed with traditional flaps. Prefabricated flaps with many advantages in reconstructing defects of oral and maxillofacial organs such as enough time for surgeon to perform surgical preparation, sculpture and form the contour and imitate the natural appearance of the real organ, may improve the aesthetic outcomes after reconstruction to a great extent.