吻合血管的小肌肉游离移植动态修复晚期面瘫

目的探讨应用吻合血管的小肌肉游离移植动态修复晚期面瘫的疗效.方法自2003年3月至2005年3月,采用吻合血管去神经的拇、趾短伸肌游离移植修复晚期面瘫患者共26例,将肌肉的肌腱端悬吊于患侧的鼻翼、鼻唇沟中点、口角及颏窝上,肌腹放置于咬肌的支配神经周围,并进行跗外侧动、静脉与颞浅动、静脉的吻合,修复由面瘫引起的口角畸形及运动障碍.结果术后即刻可矫正面部静态外观;1个月后可活动患侧口角;3个月后经训练可恢复微笑;6个月后口部活动恢复正常者23例占88%,较正常者2例占8%,略有改善者1例占4%.结论吻合血管的去神经小肌肉游离移植动态修复晚期面瘫,其肌肉无液化、萎缩少、成活可靠、神经再生确实,是重建面部表情及恢复口角功能的较成熟的修复方法.     

吻合血管的(足母)和趾短伸肌移植修复晚期面瘫

目的 探索吻合血管的去神经拇、趾短伸肌游离移植修复晚期面瘫的疗效。方法2003年4月～2005年4月,采用显微外科技术以去神经拇、趾短伸肌游离移植修复晚期面瘫26例,其中男10例,女16例。年龄16～65岁。病程6个月～60年。将肌肉的肌腱端悬吊于患侧鼻翼、鼻唇沟中点、口角及颏窝,肌腹埋藏于咬肌的支配神经周围,并进行跗外侧动、静脉与颞浅动、静脉或面动、静脉吻合,修复面瘫的口鼻畸形及运动障碍。术后采用Douglasl临床指标及Stennert评分标准进行疗效评价。结果术后26例患者的静态外观均即刻恢复双侧对称;均获随访6个月～2年。6个月后有明显的动态外观恢复：病史在2年以上者23例,除1例仅有轻微口角动度恢复外,余22例术后均可自然微笑并基本对称地暴露牙齿。病史在2年以下者3例,仅1例可自然微笑并基本对称地暴露牙齿,1例可微笑但不能对称暴露牙齿,另1例仅有口角动作但不能有协调的表情。经Douglas指标评价,效果为“卅”者共23例。经Stennert评分术前术后差值在5分以上者22例。结论吻合血管的去神经拇、趾短伸肌游离移植修复晚期面瘫,术式简便、创伤小、疗程短、效果可靠。     

吻合神经血管的股直肌肌瓣游离移植治疗晚期面瘫的改进

目的：探索吻合神经血管的动力性功能肌肉游离移植治疗晚期面瘫的方法。方法：自1994年以来我们在股直肌肌肉内神经血管解剖研究的基础上，采用带神经和肌肉内肌腱的股直肌肌瓣的吻合神经血管的游离移植治疗晚期面瘫7例。结果：术后患者于静态时双侧口角对称。2例在术后8个月恢复口角自主活动，另5例均在术后10－12个月恢复口角自主活动。结论：带肌肉肌肌腱的股直肌肌瓣的吻合神经血管的游离移植，既有利于劈裂肌肉瓣时避免血管神经损伤，又有利于维持移植肌瓣的正常肌张力以及悬吊下垂的口角。     

吻合神经血管的背阔肌瓣游离移植面瘫矫正术的整体护理

吻合神经血管的背阔肌瓣游离移植面瘫矫正术可一次完成带血管的横跨面部超长神经移植和游离肌肉移植,可为超长的神经移植体立即重建正常的血液循环,防止神经移植体因缺血而液化坏死和纤维化,促进神经再生,并减少手术次数,缩短了疗程.此手术可部分或大部分恢复患侧面肌的运动功能,使口角歪斜、眼睑闭合不全得到纠正,实现了面部肌肉的动态平衡,提高了患者的生活质量.1995年1月至1998年3月我科对18例面瘫患者采用吻合神经血管的背阔肌瓣游离移植面瘫矫正手术,临床效果满意,整体护理体会介绍如下.     

吻合血管神经的(足母)展肌移植修复晚期面瘫

目的:探讨和研究治疗晚期面瘫的手术治疗,总结应用以足底内侧动静脉为蒂的(足母)展肌游离移植一期修复晚期面瘫40例效果和经验.方法:选取(足母)展肌为供肌,以足底内侧动静脉及其延续的胫后动静脉为血管蒂,以支配(足母)展肌神经及其延续的足底内侧神经和胫神经为神经蒂.(足母)展肌移植于患侧面部皮下,肌近断固定于口角,远端固定于耳前颧弓,血管神经蒂通过上唇皮下隧道与健侧面动静脉和面神经颊支吻合.结果:经随访一年以上,23例恢复了面部静态对称和理想的下面部随意和不随意运动;8例恢复了面部静态对称和部分下面部随意和不随意运动;9例仅恢复了面部静态对称.结论:(足母)展肌游离移植一期修复晚期面瘫具有疗效好、手术操作简便、肌肉大小适中、血管神经蒂走行位置恒定紧密伴行、血管神经蒂可切取较长、变跨面神经移植和肌肉移植的两期移植为一期移植等优点;而且,神经是血管化移植.     

跨面神经结合胸小肌游离移植修复晚期面瘫畸形

报告家兔横跨面部神经移植实验研究及吻合血管神经的胸小肌游离移植治疗晚期面瘫畸形的临床实践。结果表明：横跨面部神经移植用以支配对侧表情肌是可行的。不吻合血管与吻合血管的跨面神经移植结果对比无显著差异性，提示跨面神经移植勿需强调血管吻合。腓肠神经、胸小肌游离移植是治疗晚期面瘫畸形的一种较好方法。     

跨面神经-带神经血管股薄肌游离移植分期治疗晚期面瘫

目的探讨跨面神经-带神经血管股薄肌游离移植分期治疗晚期面瘫的效果。方法回顾性分析2014年1月至2020年12月, 中国医学科学院整形外科医院整形二科应用跨面神经-带神经血管股薄肌游离移植分期治疗晚期面瘫的临床资料。一期行跨面神经移植术, 二期行带神经血管股薄肌游离移植术。术后随访手术效果, 评估患者双侧中下面部对称性变化。应用改良House-Brackmann面神经功能分级评估患者术前、后口角运动程度, 通过Adobe Photoshop 2021测量患者术前、后静态和动态双侧口角连线与面中线的夹角(口角动度客观测量), 并应用配对t检验进行比较, P<0.05表示差异有统计学意义。结果共纳入26例晚期面瘫患者, 男10例, 女16例, 年龄(24.8±3.5)岁(16～28岁)。分期手术间隔时间为6～12个月。术后随访(34.9±11.7)个月(1～3年),所有游离移植物均成活, 没有严重并发症, 其中2例患者二期术后1年因患侧面部臃肿行移植肌肉修薄术, 1例患者二期术后1年因股薄肌固定止点位置不佳进行了肌肉止点位置调整术, 1例患者二期术后2年因口角动度不足行咬肌神经跨面神...     

跨面神经结构胸小肌游离移植修复晚期面瘫畸形

报告家兔横跨面神经移植实验研究及吻合血管神经的胸小肌游离移植治疗晚期面瘫畸形的临床实践，结果表明，横跨面部神经移植用以支配对侧表情肌是可行的，不吻合血管与吻合血管的跨面神经移植结果对比无显著差异性，提示跨面神经移植勿需强调血管吻合，腓肠神经，胸小肌游离移植是治疗晚期面瘫畸形的一种较好方法。     

带神经血管肌束移植术在晚期面瘫修复中的应用

在行吻合血管神经的游离肌肉移植术修复晚期面瘫的４６例中，选择有适应证的２８例行带神经血管的背阔肌肌束移植术。该术式对肌束形态的特殊设计，不仅能作为动力重建，恢复患侧口角活动，使口角呈动态对称，而且由于带神经血管肌束对失神经肌肉有再神经化的作用，使口周及眼周多块失神经肌肉恢复神经支配及收缩功能，收到了以往手术未能达到的良好效果。详细介绍了手术适应证，手术方法及术后处理。讨论了对再生神经再教育的重要性     

腹内斜肌游离肌瓣移植一期治疗晚期面瘫

目的用带血管及多神经蒂腹内斜肌游离肌瓣移植一期治疗晚期面瘫，重建瘫痪肌肉功能。方法尸体解剖研究腹内斜肌22侧，观察形态，厚度，神经支配，血供规律，及肌切除后腹壁缺损的修复方法，在此基础上临床应用带血管及多神经蒂的游离腹内斜肌移植，一期治疗晚期面瘫。结果腹内斜肌的血供来自旋髂深动脉的腹内斜肌支，动脉直径(1.3±0.2)mm，尚有来自第11肋间动脉，直径(1.14±0.3)mm，和肋下动脉，直径(1.5±0.2)mm。旋骼深动脉或其腹内斜肌支或肋下动脉可作为腹内斜肌移植的吻接血管，腹内斜肌的神经支配来自第10，11肋间神经，长(12.7±1.5)cm.，及肋下神经，长(12.9±1.3)cm，可选用第11肋间神经或(和)肋下神经作为吻合神经。临床治疗晚期面瘫14例，随访10个月～6年，其中13例，术后移植肌肉恢复了功能，静态时口及人中歪斜消失，鼻唇沟两侧对称，微笑时两侧面部肌肉活动协调，且有的病例术后瘫痪侧眼睑能够闭合。结论用带血管及多神经蒂的腹内斜肌移植，是一期重建面部瘫痪肌肉功能的新方法，手术方便，肌肉功能较以往肌肉移植的方法恢复完全。     

Extensor digitorum brevis and extensor hallusis brevis transplantation for treatment of long-standing facial pa-ralysis

Objective: To evaluate the efficacy of free transplan-tation of denervated muscles and vessels in the treatment of long-standing facial paralysis.Methods: A total of 26 patients with facial paralysis (10 males and 16 females, aged 16-65 years, mean: 47 years) were enrolled in this study to receive transplantation of denervated extensor digitorum brevis (EDB) and extensor hallusis brevis (EHB). The muscle tendon was slung to the ala nasi, the middle point of the nasolabial sulcus, the angu-lus otis and the chin to correct the nasal and oral deformity. The muscle belly was buried around the nerves that inner-vated the masseter muscle. Microsurgery was applied to anastomosing the tarsus lateral vessels to the superficial temporalis vessels.Results: After operation, all the patients immediately obtained satisfied static appearance. The movement of the paralyzed comer of the mouth could be obtained one month later and the smile of the paralyzed side could be restored after 3 months of training. And 88% patients achieved per-fect results, 8% obtained satisfactory results, and 4% got improvement 6 months after operation according to Stennert's paresis scoring system.Conclusions: Free transplantation of denervated muscles and vessels for the treatment of long-standing fa-cial paralysis, which seldom causes atrophy or liquefaction of the transferred muscles, can maintain muscle viability and induce reliable nerve regeneration. Therefore, it is a safe and efficient treatment method for the patients suffer-ing from facial paralysis.     

动静结合的面神经瘫痪综合治疗

目的 探讨静态和动态结合综合治疗面神经瘫痪的方法。方法 1993年10月～2005年11月治疗了面神经瘫痪93例，男26例，女67例；年龄9～69岁。病程6个月～24年。不明原因发病48例，有颅内及耳手术史32例，外伤13例；其中全面神经瘫82例，向神经分支瘫11例。针对面神经瘫痪的不同情况（全瘫和分支瘫）采用了不同的修复方式，动态修复术包括手术和生物化学去神经足雌短伸肌、趾短伸肌游离移植联合颍肌筋膜瓣悬吊面瘫矫治；静态修复包括颧颊部组织上提联合颞肌筋膜瓣矫治眼闭合不全，埋设导引缝合眉上提术（单纯颞支损伤可单独应用），下颌缘支损伤采用肉毒毒素注射及健侧下颌缘支离断的两侧肌力调节。对于静态修复者，疗效的评价标准主要足面部的对称性检查，而动态修复者是联合面部对称性检查及House-Brackmann面神经功能国际评分。结果 手术和化学去神经足拇、趾短伸肌游离移植联合颞肌筋膜瓣悬吊面瘫矫治82例，面部基本对称77例，改善5例；Ⅱ级75例，Ⅲ级7例。颧颊部组织上提联合颞肌筋膜瓣矫治眼闭合不全3例，面部基本对称。埋设导引缝线眉上提术治疗15例，面部基本对称13例、悬吊脱落2例。下颌缘支损伤肉毒毒素注射及健侧下颌缘支离断的两侧肌力调节4例面部基本对称。术后随访3个月～10年，取得了较好的效果，按疗效评价标准：满意者75例，基本满意者13例，不满意者5例。采用小肌肉游离移植，短暂去神经肌肉移植后利于周围神经的长入，手术切口隐蔽，肉毒毒素的应用减少了创伤；动态和静态结合的个性化面神经瘫痪治疗，面部的改观较明显。结论 面瘫治疗需要根据面神经瘫痪不同的情况采取不同的治疗方法。     

恒河猴去神经骨骼肌游离移植的研究

目的为临床行去神经肌肉游离移植提供理论依据。方法将恒河猴的双足、趾短伸肌８块分２组去神经后游离移植于骶棘肌内，定期活检行光镜（ＨＥ染色、银染色、酶染色）及电镜观察肌纤维及神经纤维。结果去神经后肌肉的代谢降低；移植到有正常神经支配的肌肉内１２周后有神经长入。结论去神经后促进移植肌肉在缺氧环境下存活、再生，同时与受区正常肌肉接触后，有神经长入或再生神经长入并支配移植肌。本实验去神经肌肉游离移植后的存活为临床手术方法提供理论依据     

恒河猴去神经骨骼肌游离移植的研究

目的为临床行去神经肌肉游离移植提供理论依据。方法将恒河猴的双足(足母)、趾短伸肌8块分2组去神经后游离移植于骶棘肌内,定期活检行光镜(HE 染色、银染色、酶染色)及电镜观察肌纤维及神经纤维。结果去神经后肌肉的代谢降低;移植到有正常神经支配的肌肉内12周后有神经长入。结论去神经后促进移植肌肉在缺氧环境下存活、再生,同时与受区正常肌肉接触后,有神经长入或再生神经长入并支配移植肌。本实验去神经肌肉游离移植后的存活为临床手术方法提供理论依据。     

恒河猴去神经骨骼肌游离移植的研究

OBJECTIVE: This study was to provide a scientific basis for clinical application of denervated muscle transplantation. METHODS: A rhesus monkey was used in this experiment. The denervated extensor digitorum brevis (EDB) and the extensor hallucis brevis (EHB) of the rhesus monkey were autotransplanted in the sacrospinal muscle, and they were biopsied at intervals and stained with HE, Bielshowsky and enzyme. The specimen were examined with light and electro-microscope. RESULTS: The metabolism of the denervated muscle was lower than the normal. There was muscle regeneration and growing nerve fibers in the graft 12 weeks after transplantation. CONCLUSION: Denervated muscle can regenerate in oxygen-deficient environment. If the denervated muscle is in contact with normal muscle, the nerve of the recipient muscle will grow into the graft.     

The split hypoglossal nerve to supply the free functional muscle transfer in facial reanimation

Background

The introduction of the concept of free muscle transfer ushered a new era in the management of facial paralysis. Several nerves were used to supply the newly introduced muscle. The current work studies the possibility of using the split hypoglossal nerve in supplying the functional muscle transfer.

Methods

Twenty-five patients with long-standing facial nerve paralysis were treated by the author using 26 free muscle transfers and the split hypoglossal nerve. The distance and the angle of commissure excursion were measured pre- and postoperatively, and results were statistically analyzed. Only results from 24 patients were analyzed after exclusion of one patient with Mobius syndrome treated with two free flaps.

Results

The first contraction observed after muscle transfer occurred 3 to 6 months postoperatively (mean 4.6 months). Postoperatively, the gained excursion using the free latissmus dorsi flap and split lypoglossal nerve ranged between 9 and 29 mm (mean 17.75?±?6.14) and the difference in angle ranged between 0° and 19° (mean 6.88?±?5.83). None of our patients complained of mastication or speech problems.

Conclusions

Within the limitations of the present study, the split hypoglossal nerve is probably a possible alternative donor nerve to supply the free functional muscle transfer in long-standing facial nerve paralysis. Level of Evidence: Level IV, therapeutic study.     

Microneurovascular free abductor hallucis muscle transplantation for resuscitation of facial paralysis in one stage]

After study of local anatomy in fresh cadaver the authors carried out free abductor hallucis muscle transplantation successfully in three patients with facial paralysis. In one patient the plantaris medialis vessels were anastomosed to the contralateral facial vessels and the plantaris medialis nerve was anastomosed to buccal branch of the contralateral facial nerve. In two patients the plantaris medialis vessels were anastomosed to the ipsilateral facial vessels and the plantaris medialis nerve was anastomosed to the myloidens branch from ipsilateral trigeminal nerve. The authors described the local anatomy and operative methods in details. The advantages of this operative method were also discussed.     

Paralysis of the marginal mandibular branch of the facial nerve: treatment options.

Isolated paralysis of the marginal mandibular branch of the facial nerve results in an asymmetrical smile with elevation of the lower lip on the affected side. We discuss the surgical options for its correction and present a series of 26 patients who underwent either botulinum toxin injection, anterior belly of digastric transfer or free extensor digitorum brevis transfer as treatment. Botulinum toxin injection provided satisfactory results although these were temporary. Anterior belly of digastric transfer was the surgical procedure of choice. It yielded superior cosmetic results, less donor-site morbidity and required a shorter operating time. In more complex congenital facial hypoplastic syndromes, or following extensive surgery in the digastric triangle, the anterior belly of the digastric muscle may be absent or damaged. Extensor digitorum brevis transfer is the preferred option in these cases.