胸部多源血供皮瓣在颌颈部组织缺损或畸形修复中的应用

Application of thoracic skin flap with multiple blood supply in repair of tissue defects and deformities in jaw and neck

目的探讨颌颈部组织缺损和畸形的适宜修复方法。方法2006年1月-2008年11月，笔者采用胸部多源血供皮瓣（含预扩张皮瓣）对18例严重颌颈部组织缺损或畸形患者进行修复，分别选取颈横动脉前皮支、胸廓内动脉肋间前穿支、胸外侧动脉作为皮瓣的血管蒂。结果除1例患者颈横动脉前皮支岛状皮瓣远端形成小范围表皮水疱，经短期换药愈合外，其余皮瓣完全成活；颌颈部组织缺损或畸形得到了较好的修复。随访6个月～2年，患者修复处外观及功能满意，无继发畸形。结论胸部皮瓣血供来源多而恒定，在考虑患者的主观要求、全身情况、缺损部位和范围的前提下，选择以适宜血管为蒂的胸部岛状或窄蒂皮瓣可以达到良好的修复效果。

Objective To explore an appropriate measure to repair tissue defects and deformities in mandibulo-cervical region. Methods Eighteen cases with severe tissue defects and deformity in jaw and neck were repaired with thoracic skin flap with multiple blood supply system in our unit from Jan. 2006 to Nov. 2008. Anterior cutaneous branch of transverse cervical artery, intercostal branch of internal thoracic artery and lateral thoracic artery were included in the pedieles. Results All skin flaps survived, except in one patient in whom a small belb appeared at the distal end of the island flap with anterior cutaneous branch of transverse cervical artery, and it was healed after a few dressing changes. The functions and appearances were satisfactory after 6-month to 2-year follow-up, without showing secondary deformity. Conclusions The blood supply of thoracic skin flap is abundant and constant, which is an ideal method for repair of tissue defects and deformities in jaw and neck after taking into account some factors, such as the demand of the patient, general physical condition, and the size of the defect.