股前外侧皮瓣在口腔颌面外科的临床应用

Clinical application of free anterolateral thigh flap in oral and maxillofacial surgery

目的：探讨应用血管化游离股前外侧皮瓣（free anterolateral thigh flap，ALTF）修复口腔颌面外科组织缺损的临床特点与治疗效果。方法：选择2011年1月至2013年2月间我科收治的39例因各种原因导致的颌面部缺损的患者，其中因1：3腔癌手术扩大切除后致缺损的患者35例，因面部巨大神经纤维瘤切除术后致缺损的患者1例，因外伤致颌面部软组织缺损的患者3例。术中均切取与受区大小相适应的皮瓣，部分皮瓣带有肌袖以填塞死腔，并将旋股动脉的降支与颌外动脉或甲状腺上动脉做端端吻合，将血管蒂部的伴行静脉与颈内静脉或颈外静脉做端侧吻合。观察移植后的皮瓣存活情况及受区功能重建的特点。结果：39例患者中36例皮瓣顺利成活，1例糖尿病患者术后15h出现静脉血管危象，经积极抢救皮瓣仍全部坏死；2例患者术后10～15h出现静脉危象，经抢救完全存活。术后随访6—30个月，平均9．7个月，受区皮瓣表面积无缩小，皮下脂肪1／3～1/2吸收，供区组织线性瘢痕，无明显畸形，腿部活动正常。结论：血管化游离ALTF具有切取简单易学、可塑性强、受区外形及功能满意、供区组织量丰富、血管位置恒定及血管蒂长、供区外形及功能影响小等优点，可广泛应用于口腔颌面外科组织缺损的修复重建。

Objective：To investigate the clinical features and efficacy of vascularized free anterolateral thigh flap（ALTF） for repair of tissue defects in oral and maxillofacial surgery. Methods：Totally 39 patients with maxillofacial defects due to different causes in our department between January 2011 and February 2013 were enrolled in our study including 36 cases caused by extended resection of oral and maxillofacial carcinoma, one case caused by resection of facial giant neurofibroma and 3 cases of maxillofacial soft tissue defect by injury. During the surgery,flaps at a size equivalent to recipient area were cut and some flaps with muscle sleeves were used to fill the dead spaces;the descending branch of the femoral artery was end-to-end anastomosed with external maxillary artery and the accompanying vein of the vascular pedicle was end-to-side anastomosed with the internal jugular vein or external jugular vein. The survival of the flap graft and the characteristics of the functional reconstruction of the recipient area were recorded. Results ： Of the 39 cases,36 showed survival of skin flaps. One patient with diabetes melfitus presented with venous vascular crisis at 15 h after the surgery and then experienced total necrosis of skin flaps in spite of the active rescue. Two patients presented with venous vascular crisis at 10- 15 h after the surgery and survived completely after the rescue. The patients were followed-up for 6-30 months（mean 9.7 months）. There was no shrinkage of the surface area of the flaps in the recipient area. 1/3-1/2 of the subcutaneous adipose tissues were absorbed. Linear scar tissue formed in the donor area yet without no significant deformity and the legs had normal activity. Conclusion：Vascularized free ALTF is characterized by advantages of simple operation, easy to learn,plastic,satisfactory in shape and function of the recipient area,rich in tissue dose in the donor area,constant in the location of blood vessels,long in vascular pedicle length and little impact on the appearance and function of the donor area. Thus it can be widely applied in the tissue defect reconstruction in oral and maxillofacial surgery.