背阔肌游离肌皮瓣用于颅颌面部缺损重建

Transplantation of free latissimus dorsi myocutaneous flaps for craniomaxillofacial reconstruction

目的 提高颅颌面部组织缺损的修复水平。方法 本组 8例颅颌面部组织缺损患者 ,皮肤和黏膜缺损面积最小 10cm× 8cm ,最大 30cm× 12cm ,应用背阔肌游离肌皮瓣移植修复 ,所有皮瓣的神经均与受区神经吻合。 7例患者一期手术完成 ,另 1例分 3次手术完成 :第 1次行皮瓣延迟 ,第 2次手术行游离皮瓣移植 ,第 3次手术行口角成形术。肌皮瓣面积最小 12cm× 10cm ,最大 32cm× 16cm。结果 术后随访 6个月～ 4年 ,所有患者功能和形态满意 ,感觉恢复良好 ,无皮瓣发生坏死和溃疡。结论 背阔肌游离肌皮瓣移植是一种修复严重颅颌面部组织缺损的较为理想的方法 ,具有血供可靠、抗感染力强、供瓣面积大、供区隐蔽、可重建运动和感觉功能等优点。

Objective This clinical study was to improve the surgical treatment to craniomaxillofacial tissue defects. Methods Since 1997,eight cases with severe craniomaxillofacial defects were treated using free latissimus dorsi myocutaneous flaps.In the operation,nerve anastomosis was performed.Of the 8 cases,7 were treated in one stage,1 was treated in 3 steps.The craniomaxillofacial defects ranged from 10 cm×8 cm to 30 cm × 12 cm. The flaps was 12 cm×10 cm to 32 cm×16 cm in size. Results Postoperative follow-up for 6 months to 4 years demonstrated satisfactory results in all the cases.There was neither necrosis nor ulcer after the operation.The sensation recovery of the flap was also satisfactory. Conclusion Free transfer of the latissimus dorsi myocutaneous flap is an ideal treatment to severe craniomaxillofacial defects as it possesses the advantages of reliable blood supply,ability against infections,large size,concealed donor site,and functional restoration of sensation and movement.