游离腹直肌肌皮瓣移植颅面部巨大缺损一期整复术

One-stage reconstruction of large complex defects in craniofacial region with free rectus abdominis myocutaneous flap(FRAMF)

目的 :探讨修复巨大颅面缺损的手术方法。方法 :采用显微血管外科技术 ,对 4例颅面部晚期癌肿切除术后形成的巨大缺损施行游离腹直肌肌皮瓣移植一期整复术。其中右侧上颌窦巨大恶性血管外皮瘤侵犯颜面眼眶及颅底 1例 ,左上颌骨癌侵犯面颊及鼻背 1例 ,左上颌骨纤维肉瘤侵犯眼眶及侧颅底 1例 ,左上颌骨癌上颌骨切除术后放疗面颊部软组织大面积坏死 1例。结果 :4例游离腹直肌肌皮瓣均以腹壁下动脉为血管蒂 ,皮瓣的皮岛最小 6× 9cm,最大 12× 15cm,切取腹直肌的大小依照待修复区充填缺损所需组织量的多少而定。根据所修复的部位受区血管有所不同。术后皮瓣全部成活 ,局部整形效果满意。结论

Objective:To find the best way to repair large comlex defects in cranio facial region.Methods:Four patients with large cranio facial defects were reconstructed with free rectus abdominis myocutaneous flap (FRAMF) by microvascular technique.OF all these cases,one was of large malignant vascular exothelioma invading anterior skull base and orbital facial region;one was of maxillary cancer invading lateral skull base;one of maxilla fibrosarcoma invading orbit and lateral skull base and the other one of maxillary sinus cancer with facial soft tissue necrosis because of postoperative radiation.Results:The FRAMF in the above 4 patients kept the inferior epigastric vessels as the vascular pedicle and the sizes of skin island of the flap ranged from 6×9cm to 12×15cm.There was no flap necrosis and no other major complications except one with slight infection.Conclusion:FRAMF is a reliable and ideal flap in the reconstruction of large complex defects resulting from tumor in cranio facial region. [Chinese Arch Otolaryngol Head Neck Surg,2000;7(1):33~36 From the Department of Otolaryngology Head and Neck Surgery,First Clinical College of Norman Bethune University of Medical Sciences,Changchun,130021 (Dr.Li Xiao ming)]