显微外科方法治疗面部不对称畸形受区血管的选择

Recipient vessel analysis for microsurgical treatment of asymmetrical facial deformities

目的:探讨显微外科方法治疗面部不对称畸形受区血管的选择。方法:总结了我院自2004年9月至2006年6月共收治面部不对称畸形31例。其中半侧颜面萎缩19例,第一、二鳃弓综合征4例,放疗、外伤、肿瘤切除术后和感染导致半侧颜面不对称共8例。背阔肌肌瓣移植6例,股前外侧脂肪筋膜瓣移植25例。用作受区的血管有颞浅动静脉、舌下动脉、面动静脉、甲状腺上动脉、颈外静脉、颈前静脉。结果:1例脂肪筋膜瓣术后少许脂肪液化。其他瓣完全成活。6个月后随访发现瓣均出现不同程度的萎缩、吸收或下移,3例在门诊进行瓣的再次修整。术后畸形均不同程度改善。结论:术前需要对受区血管的选择进行综合判断。建议首选舌动脉或甲状腺上动脉,静脉选用颈外静脉。

Objective To study how to select the recipient vessels for microsurgical treatment of asymmetrical facial deformities Methods A total of 31 patients,including progressive facial hemiatrophy （n=19）, the first and second branchial arch syndrome （n =4）, asymmetrical facial deformities caused by radiotherapy, traumatism, malignancy resection （n=8） were summarized. Latissimus dorsi myocutenous flaps （n=6） and antelateral femoral fasicoadipose flaps （n=25） were selected. Superficial temporal vessels, sublingual arterys, facial vessels, superior thyroid arterys, external jugular veins, anterior jugular veins were candidates of recipient vessels Results One superficial temporal venous thrombosis occurred at the 2nd postoperative day. One flaps showed partly necrosis. Others survived unevently. A good cosmetic results were achieved in all cases Conclusion Recipient vessels must be assessed preoperatively by multiple factors and superior thyroid arterys, external jugular veins firstly were considered to as recipient vessels.