数字化技术设计股前外侧皮瓣在修复重建颌面部缺损中的应用效果

Application of Repair and Reconstruction of Maxillofacial Defect with Anterolateral Thigh Flap Designed by Digital Technique

目的:探讨数字化技术设计股前外侧皮瓣(Anterolateral thigh flap,ALTF)修复重建颌面部缺损的可行性及精确性。方法:纳入2019年6月-2020年6月笔者医院口腔颌面外科收治的15例颌面部缺损患者,采用彩色超声对股前外侧皮瓣穿支的位置进行定位,对下肢进行CT扫描获取CT参数,利用软件对股前外侧皮瓣进行设计,对皮瓣的体积进行计算并进行皮瓣的制备,对术中实际皮瓣的体积进行测量。术后随访3个月,观察皮瓣成活及供区愈合情况,对口腔功能及外形美观进行评分,比较术前超声定位的皮瓣穿支位置与术中实际穿支位置的符合率,术前设计皮瓣体积与术中实际皮瓣体积的差异。结果:15例皮瓣均成活,13例供区为一期愈合,2例供区经过1周的换药后愈合;患者的口腔闭合、言语功能、咀嚼功能、吞咽功能及外形美观评分分别为(8.752±0.70)分、(8.83±0.79)分、(8.90±0.44)分、(8.24±0.55)分、(8.99±0.72)分,术前超声定位的皮瓣穿支位置与术中实际穿支位置的符合率为86.67%;术前设计皮瓣体积与术中实际皮瓣体积比较,差异无统计学意义(P>0.05)。结论:数字化技术设计ALTF修复重建颌面部缺损具有较好的可行性及精确性。

Objective To discuss the feasibility and accuracy of repair and reconstruction of maxillofacial defect with anterolateral thigh flap(ALTF) designed by digital technique.Methods 15 patients with maxillofacial defect who were continuously included in department of stomatology of our hospital from June 2019 to June 2020.The color ultrasound was used to locate the perforator of the anterolateral thigh flap,CT parameters were obtained by CT scanning of lower limbs,software was used to design the anterolateral thigh flap,the volume of lap was calculated and flap was prepared,and the intraoperative actual volume of flap was measured.All the patients were followed-up for 3 months,the flap survival nad donor heali was observed.The oral function and aesthetic appearance wase evaluated.The coincidence rate between flap perforator position of preoperative ultrasound localization and intraoperative actual perforator position,the difference between preoperative designed flap volume and intraoperative actual flap volume was compared.Results 15 cases of flaps were survived.13 cases of donors were grade Ⅰ healing,2 cases of donors were healing after dressing for 1 week.The scores of oral closure,speech function,chewing function,swallowing function and aesthetic appearance were (8.752±0.70),(8.83±0.79),(8.90±0.44),(8.24±0.55) and (8.99±0.72),respectively.The coincidence rate was 86.67% between flap perforator position of preoperative ultrasound localization and intraoperative actual perforator position.There was no statistically significant difference between preoperative designed flap volume and intraoperative actual flap volume(P>0.05).Conclusion ALTF designed by digital technique had good feasibility and accuracy in repair and reconstruction of maxillofacial defect.