口腔颌面缺损游离组织移植修复138例临床分析

Microvascular free flaps in oral and maxillofacial reconstruction:a report of 138 cases

目的探讨影响游离组织移植成功的因素,为各种游离组织瓣在口腔颌面头颈外科的应用提供临床参考。方法收集2005年1月～2008年6月进行游离移植的138例组织瓣,其中前臂皮瓣46例,游离背阔肌瓣10例,股前外侧皮瓣3例,足背皮瓣1例;腓骨肌瓣39例,腓骨肌瓣联合小腿外侧皮瓣36例,髂骨肌瓣3例。修复良性肿瘤术后缺损者41例,恶性肿瘤术后缺损者96例,发育畸形1例。血管吻合采用改良的二定点吻合法。结果 138例游离移植的组织瓣的成功率为99%以上,有1例足背皮瓣在术后7天出现静脉危象,第8天皮瓣坏死。1例腓骨肌瓣联合小腿外侧皮瓣患者手术后12h出现动脉危象,经抢救成活。2例前臂皮瓣和1例腓骨瓣术后24小时内出现静脉危象,经过重新吻合后抢救成功;1例前臂皮瓣在术后第6天出现静脉危象,抢救成功。其它132例游离组织瓣均达到Ⅰ期临床愈合。结论影响游离组织瓣移植成活的因素很多,血管吻合技术以及吻合后血管蒂的摆放是成功的关键。为了防止术后静脉危象的出现,在可能的情况下尽量吻合2根静脉。

Objective To evaluate the influencing factors on the success of free flaps for the oral and maxillofacial reconstruction. Methods A total of 138 free flaps were summarized, including 46 radial forearm free flaps, 10 latissimus dorsi myocutaneous flaps ,3 anterior-lateral thigh flap, 1 dorsalis pedis flap, 39 fibular flaps,36 free fibular combined with lateral crural flaps, and 3 iliac crest flaps. Forty-one defects after benign lesion resection and 96 defects after malignant tumor surgery were reconstructed. A modified microvascular anastomosis was used in this study. Results The overall success rate of microvascular free flaps was over 99% in this study. One dorsalis pedis flap failed seven days after operation. One arterial insufficiency was salvaged 12 hours after operation. Two radial forearm free flaps, one fibular flap got venous congestion within 24 hours after the initial operation and successfully salvaged. One radial forearm free flap underwent late internal jugular vein congestion 6 days after operation and salvaged by bridging venous pedicle. Conclusion The skills of microvascular anastomosis as well as vascular pedicle placement following anastomosis are essential for the success of microvascular free flaps. To prevent venous congestion,wherever possible, two venous systems should be used.