腹内斜肌游离肌瓣移植一期治疗晚期面瘫

Neurovascular obliquus internus abdominis flap free transfer for facial reanimation in one stage

目的 用带血管及多神经蒂腹内斜肌游离肌瓣移植一期治疗晚期面瘫 ,重建瘫痪肌肉功能。方法 尸体解剖研究腹内斜肌 2 2侧 ,观察形态 ,厚度 ,神经支配 ,血供规律 ,及肌切除后腹壁缺损的修复方法 ,在此基础上临床应用带血管及多神经蒂的游离腹内斜肌移植 ,一期治疗晚期面瘫。结果 腹内斜肌的血供来自旋髂深动脉的腹内斜肌支 ,动脉直径 (1 3± 0 2 )mm ,尚有来自第 11肋间动脉 ,直径 (1 14± 0 3)mm ,和肋下动脉 ,直径 (1 5± 0 2 )mm。旋骼深动脉或其腹内斜肌支或肋下动脉可作为腹内斜肌移植的吻接血管 ,腹内斜肌的神经支配来自第 10 ,11肋间神经 ,长 (12 7±1 5 )cm .,及肋下神经 ,长 (12 9± 1 3)cm ,可选用第 11肋间神经或 (和 )肋下神经作为吻合神经。临床治疗晚期面瘫 14例 ,随访 10个月～ 6年 ,其中 13例 ,术后移植肌肉恢复了功能 ,静态时口及人中歪斜消失 ,鼻唇沟两侧对称 ,微笑时两侧面部肌肉活动协调 ,且有的病例术后瘫痪侧眼睑能够闭合。结论 用带血管及多神经蒂的腹内斜肌移植 ,是一期重建面部瘫痪肌肉功能的新方法 ,手术方便 ,肌肉功能较以往肌肉移植的方法恢复完全。

Objective To study the anatomy and transplantation of the obliquus internus abdominis with multiple nerve and a vascular pedicle for facial reanimation in one stage. Method Eleven adult cadavers (22 sides) were anatomized to observe the shape, thickness, innervation and rule of blood supply of the obliquus internus abdominis. Fourteen cases of long established facial paralysis were treated with transplantation of the obliquus internus abdominis flap with one or two neurovascular pedicles from 1995 to 1999. Results The blood supply of the obliquus internus abdominis mainly comes from the obliquus internus abdominis branch of the deep circumflex iliac artery (1.3 ± 0.2 mm in diameter), some come from the eleventh intercostal artery (1.14 ± 0.3mm) and the infracostal artery (1.5 ± 0.2mm). The branch of the deep circumflex iliac artery and its concomitant vein or infracostal artery and its concomitant vein could be anastomosed for muscle transplantation. The innervation of the obliquus internus abdominis comes from the tenth and eleventh intercostal nerves (12 7 ± 1 5 cm in length) and the infracostal nerve (12.9± 1.3 cm in length). The eleventh intercostal nerve and the infracostal nerve have been selected for anastomosis in muscle transplantation. Fourteen cases with long established facial paralysis have been treated by free obliquus internus abdominis flap transfer with one or two neurovascular pedicles in one stage. They have been followed up for 10 months to 6 years. Of those patients, 13 have restored the dynamic functions of transplanted muscles, mouth and philtrum deviation has been corrected in the static state; the facial muscles activities are harmonized while smiling. The eyelids of the paralyzed side can close after operation, which reveals the function of ocular orbicularis of the paralyzed side has been restored. Conclusions The one-stage free transplantation of the obliquus internus abdominis flap with one or two neurovascular pedicles is a new method for facial reanimation in the treatment of long established facial paralysis. Because of the simpleness of the procedure and the completeness of functional reanimation of paralyzed facial muscles, it is one of the ideal procedures for facial reanimation.;