Romberg's病畸形的外科综合矫治

The overall correction of Romberg's disease with free anterolateral thigh adipofascial flap as the main method

目的:探讨以股前外侧脂肪筋膜瓣游离移植为基础进行综合序列矫治中重度Romberg’s病畸形的方法和经验。方法:对半侧颜面萎缩畸形进行分期综合矫治,Ⅰ期采用吻合血管的股前外侧脂肪筋膜瓣植入矫正软组织凹陷,部分病例同期植入高密度多孔聚乙烯(商品名Medpor)矫治颅颌面骨缺损;Ⅰ期治疗恢复后,针对半侧颜面颅颌面骨、眼、鼻、唇畸形,以及股前外侧脂肪筋膜瓣植入后产生的继发畸形,进行综合修复。结果:从1996年10月～2007年10月,收治32例中重度Romberg’s病患者。Ⅰ期手术植入33块股前外侧脂肪筋膜瓣修复软组织缺损,切取皮瓣面积20cm×11cm～12cm×8cm,组织瓣成活良好。20例行面部Medpor填充颅颌面骨骼重建。共有22例行Ⅱ期修复,7例行Ⅲ期修复,1例行Ⅳ期修复。随访6个月到7年,面部形态基本对称,外形满意,大腿功能无明显受限。结论:采用这种方法系统、综合矫正Romberg’s病畸形,能够获得比较满意的手术效果,是一种可行的治疗方法。

Objective To explore the method and experience in correcting intermedium and severe Romberg＇s disease based on free anterolateral thigh adipofascial flap in a serial and synthetic way. Methods The deformities of Romberg＇s disease were corrected with multistaged methods. In the first stage, the vasculized free anterolateral thigh adipofascial flap was tranfered into face to correct the depression of soft tissue, and Medpor was implanted to correct the defect of the craniomaxillofacial bone in part of cases. The secondary surgeries were the combined reconstruction of the deformties in eye,nose,lip and craniomaxillo-facial bone after the restoration of the soft tissue contour by the free anterolateral thigh adipofascial flap. Results 32 medium-severe patients were involved between October 1996 and October 2007,33 flaps were transfered to correct the soft tissue defect. The size of flap ranged from 20cm ×11cm to 12cm ×8cm and all the flap survived except 1 flap with partial loss. Medpor implantation to reconstruct cranio-maxillo- facial framework was performed in 20 cases. 22 cases undergone two-staged surgery. 7 cases had to be rectified in the third stage. 1 case was revised in the fourth stage. The patients were followed-up for 6 months to 7years .The faces of the patients were symmetric roughly, the esthetic appearance was acceptable, there were no donor site morbidity. Conclusion The synthetic correction of Romberg,s disease with free anterolateral thigh adipofascial flap as the main method come out with satisfactory clinical outcome ,and it is feasible in treating Romberg,s disease.