应用不同吻合血管的游离皮瓣修复面部皮肤软组织缺损

Reconstruction of facial soft tissue defects with free flaps by microsurgery

目的探讨临床应用不同吻合血管的游离皮瓣修复面部复杂性软组织缺损的方法，以及适应证的选择。方法利用不同的游离皮瓣对37例（男16例，女21例，年龄1-54岁）不同原因所致面部软组织缺损进行修复，其中背阔肌肌皮瓣10例，胸背动脉的穿支皮瓣3例，肩胛皮瓣9例，前臂皮瓣6例，耳后皮瓣9例；修复缺损面积1cm×2cm-25cm×12cm。结果除耳后皮瓣移植有3例出现静脉回流障碍致2例部分坏死外，其余移植的皮瓣全部成活，组织缺损得以修复，明显改善了功能及外形。结论根据患者的不同情况，选择合适的吻合血管的游离皮瓣移植修复面部复杂性皮肤软组织缺损，可以一期闭合创面并较好地重建功能、恢复外形。

Objective To investigate the method and indications for reconstruction of facial complicated soft tissue defects with free flaps by microsurgery. Methods 37 patients （16 males and 21 females, aged from 1 to 54 years） with different size of facial soft tissue defects were reconstructed with free flaps, including 10 latissmus dorsi myocutaneous flaps, 3 thoracodorsal artery perforator flaps, 9 scapular flaps, forearm flaps and 9 postauricular flaps. The defects size ranged from 1 cm × 2 cm to 25 cm × 12 cm. Results Venous obstruction happened in 3 postauricular flaps, resulting partial necrosis in 2 flaps. All the other flaps survived completely. The cosmetic and functional results were both satisfactory. Conclusions The facial complicated soft tissue defects can be treated successfully with free flaps by microsurgeiy. The wounds can be healed primarily with short recovery time and reliable cosmetic and functional result.