同种异体头皮、面颈部和双耳廓复合组织移植术

Allograft transplantation with compound tissue of two ears and skin of head and neck: A report of 1 case,China

目的 探讨采用同种异体头皮、面颈部和双耳廓复合组织移植术 ,修复“巨大恶性黑色素瘤病灶扩大切除术”后头面部及颌颈部巨大组织缺损的效果和可行性。方法 供体选择血型相配的脑死亡者。切取层次在头顶部达骨膜或帽状筋膜层间 ,双侧颞部达颞深筋膜浅层 ;面颈部紧贴颧骨、下颌骨切取 ,包括咀嚼肌、耳廓、胸锁乳突肌、颈部血管、颈外血管。受区先经修整 ,移植时首先将双侧供、受体的外耳道对合并缝合 ,然后吻合供、受体颈部血管 ,最后间断缝合额部颞皮肤及顶枕部头皮。术后采用FK5 0 6、骁悉 (MMF)、激素 (Pred)、赛尼哌 (zenapax)四联免疫抑制方案。观察移植头皮瓣生长及排斥情况 ,同时监测FK5 0 6血浓度及免疫学指标。并于术后第 1、4、8h及第 7天、14天、1月取活检送病理检查。结果 移植的头皮瓣及双耳廓血循环良好 ,皮肤色泽正常、温热。缝合处一期愈合 ,头发生长良好 ,1个月生长约 0 8cm ,且无明显脱发。术后各次头皮取活检送病理检查结果均未显示有急性排斥反应。术后 1个月时FK5 0 6浓度维持在 2 0mg ml左右。结论 同种异体头皮瓣 (包括双耳 )移植术 ,可用以修复头面颈巨大组织缺损。良好的组织配型 ,合理的免疫抑制剂联合应用方案 ,可以有效地预防移植的超急性和急性排斥反应。

Objective To investigate the possibility and efficacy of allograft transplantation in treating patient with huge tissue defect after radical giant malignant melanoma resection. Methods A male person received blood type matching was chosen as donor. Immediately after the donor’s brain death, allograft was excised with the depth to the layer intervenient between periosteum and epicranial fascia in calvaria,the superficial layer of deep temporal fascia in both sides of temporal regions, close to zygomatic bones and mandibles including masseter and auricles upon in face, and cervical soft tissues including sternocleidomastoid muscles, cervical and external jugular vessels of both sides were excised simultaneously. After being perfused with 4℃ UW solution through both common carotid arteries, the homograft was sheared and radiated with X-ray before being preserved in UW solution for further use. During the operation, both sides of external auditory meatus were anastomosed with ears firstly, and vessels were anastomosed end-to-end sequently, at last, the border of skin flap was sutured intermittently. Combined use of MMF, FK506, Prednisone and Zenopax was performed as post-operation immunosuppressive treatment. Clinical observations were made on the signs and symptoms of graft survival or rejection as well as blood FK506 concentrations and immunological indexes were tested in laboratory. Biopsies of graft were also made at 1h, 4h, 8h, 7d, 14d and 30d after operation. Results The circulation of the graft was satisfactory, and the temperature and color of skin were normal. Primary healing of suture and hair growth about 0 8 cm in a month were observed. Skin Biopsies of every time had no found of hyperacute or acute rejection. The concentration of FK506 was maintained 20 mg/ml 1 month after the operation. Conclusion Allograft transplantation with compound tissue of head skin flap and ears is a kind of effective and safe treatment in repairing huge tissue defect. Good tissue matching and combined use of currently available immunosuppressants can prevent hyperacute and acute rejection efficiently. ;