面部自由式穿支蒂皮瓣的解剖基础及其修复眶睑部软组织缺损

Anatomic study and clinical application of freestyle perforator pedicle flap of eyelid soft tissue defect

目的探讨3种自由式穿支蒂皮瓣修复眶睑部软组织缺损的解剖基础及应用方法。方法(1)选用5具新鲜明胶氧化铅灌注的新鲜尸头,制备3种自由式穿支蒂皮瓣模型,观察源血管及穿支的分布和来源;(2)回顾性分析2015年1月至2021年6月安徽医科大学第一附属医院整形外科应用自由式穿支蒂皮瓣修复眶睑部缺损患者25例,缺损面积1.5 cm×1.0 cm~4.0 cm×3.0 cm不等,分别采用的自由式类型为鼻唇沟-内眦动脉穿支蒂皮瓣、颞部-颧眶动脉穿支蒂推进皮瓣、眉间-滑车动脉穿支蒂皮瓣进行修复。结果(1)解剖学结果:眶睑外侧缘颞浅动脉向眶睑部发出颧眶动脉支配眼轮匝肌的血管,并形成大量的吻合支。眶睑部下缘中面部从面动脉开始,游离出内眦动脉,鼻背动脉及与眼轮匝肌吻合的血管,三者之间在眶睑部有丰富的吻合支;眶睑中内侧游离出滑车上动脉发出多个穿支营养上睑内侧区域,测量上述动脉发出穿支直径为(0.63±0.18)mm。(2)25例皮瓣全部存活,切口一期愈合。术后经1~24个月随访,患者术后眶周形态恢复良好,未见眼睑外翻等并发症,未见癌种复发。结论根据眶睑部缺损部位及大小选择3种自由式皮瓣修复。自由式穿支蒂皮瓣切取简单、损伤小,是修复眼周中小面积软组织缺损较适宜方法。

Objective To investigate the application methods and clinical effects of three kinds of freestyle perforator pedicle flaps in repairing orbital and eyelid defects.Methods(1)Five fresh cadaveric heads perfused with fresh gelatin to prepare models of three kinds of flap were choosed,the distribution and origin of the blood vessels and their perforators were investigated.(2)A retrospective analysis was performed on 25 cases of patients with orbital defects repaired via freesyle perforator pedicle flap in plastic surgery department of the First Affiliated Hospital of Anhui Medical University from January 2015 to June 2021.The defect area ranged from 1.5 cm×1.0 cm to 4.0 cm×3.0 cm.The freestyle types included nasolabial sulcus-medial canthus artery perforator pedicle flap,temporal-zygomatic artery perforator pedicle flap and interbrow-trochlear artery perforator pedicle flap.Results(1)The superficial temporal artery sends out the vessels of the zygomatic artery to the orbital eyelid to supply the orbicularis oculi muscle and forms a large number of anastomotic branches.In the lower margin of the orbital eyelid,the Medial canthus artery,dorsal nasal artery and anastomotic vessels with orbicularis oculi muscle were separated from the facial artery.There were abundant anastomotic branches in the orbital eyelid.The medial side of the orbital eyelid was separated from the superior trochlear artery to give off multiple perforations nourishing the medial side of the upper eyelid.The average diameter of the perforations of the above-mentioned arteries was about(0.63±0.18)mm.(2)All the 25 flaps survived.After 1 to 24 months of followed-up,there were no complications such as eyelid ectropion and recurrence of cancer.Conclusion Three kinds of skin flaps were selected according to the defect location and size.Freestyle perforator pedicle flap is a suitable method to repair soft tissue defect in small area around the eye because of its simple incision and small damage.