旋髂深动脉穿支嵌合髂骨皮瓣修复下颌骨复合性缺损

目的 探讨旋髂深动脉穿支嵌合髂骨皮瓣（DCIAPF）在下颌骨复合性缺损重建中的应用价值与优缺点。方法 2014年3-7月应用DCIAPF游离移植一期修复6例下颌骨及软组织复合缺损患者。根据术前定位的旋髂深动脉皮肤穿支设计并逆行切取皮岛,随后于腹股沟区顺行解剖血管蒂并切取髂骨瓣,继续解剖旋髂深血管直至终末段与皮岛相续。完成DCIAPF切取后供区分层严密关闭以预防腹疝。结果 6例患者所制备的髂骨瓣长5.0~11.0 cm,皮岛3.5 cm×5.0 cm~7.0 cm×10.0 cm,供区均一期关闭未行植皮。1例皮岛穿支来自旋髂浅血管需另行吻合,其余5例成功制备为DCIAPF。移植的髂骨皮瓣均成活,仅1例因行皮岛修薄处理出现表皮剥脱和少量边缘坏死,经修剪及换药处理后愈合。术后随访3~6个月,牙槽嵴高度恢复满意,供区均未出现明显并发症。结论 DCIAPF血运丰富可靠,能提供足够的骨量供下颌骨重建并恢复牙槽嵴高度,为后期义齿修复创造有利条件;其皮肤穿支解剖较为恒定,携带皮岛组织量大,摆放灵活,供区隐蔽,是下颌骨复合性缺损修复重建的有效方法。     

多种组织瓣在口腔颌面部组织缺损中的应用

目的：总结12种组织瓣整复口腔颌面部软组织缺损的临床应用价值、技术特点及适应症。方法：对68例口腔颌面部大、中型组织缺损的患者，立即用带蒂肌皮瓣和游离组织瓣进行舌、口底、面颊部、腮腺区等部位的修复重建，并对效果进行观察。结果：54块带蒂肌皮瓣成功率为96．3％（52／54），使用最多的是胸大肌皮瓣；17块游离组织瓣成功率为88．3％（15／17），使用最多的是前臂游离皮瓣。所用各类组织瓣修复效果良好。结论：用组织瓣立即整复口腔颌面部组织缺损，可及时恢复口腔颌面部功能，对提高患者生存质量起到积极作用。     

A combined superficial inferior epigastric artery flap and vascularized iliac crest flap in the reconstruction of extended composite defects of the posterior mandible and adjacent soft tissue: first clinical results

The technique of posterior facial reconstruction using a combination of a superficial inferior epigastric artery (SIEA) flap and a microvascular iliac crest flap (deep circumflex iliac artery (DCIA) flap) is described. 12 cases are reported. The patients had unilateral squamous cell carcinoma of the posterior mandible affecting parts of the soft palate and tonsil region or the posterior cheek. In all patients unilateral neck dissection, resection of the posterior and lateral mandible, was performed. Reconstruction was carried out during primary surgical therapy, followed by postoperative radiotherapy. A flap combination of a SIEA and a DCIA flap was used. There were no problems with pedicle length or anastomoses. There was no flap loss or severe postoperative complications. All patients had good aesthetic and functional results. One patient had distant metastases 2 years postoperatively. All other patients were free of tumour relapse or metastases within 12-58 months of follow up. The SIEA flap and vascularized iliac bone flap combination is useful in reconstructing the posterior face. The iliac bone flap is well suited for posterior mandible reconstruction and the SIEA flap for reconstruction of the soft palate, lateral pharyngeal wall and cheek. Both flaps are harvested from the same donor site.     

游离皮瓣移植修复口腔颌面部缺损的临床效果观察

目的探讨游离皮瓣在修复口腔颌面部缺损中的临床应用价值。方法选择2006年03月—2010年08月中国医科大学口腔医学院口腔颌面外科用游离皮瓣修复口腔颌面部缺损病例168例,前臂游离皮瓣90例,股前外侧游离皮瓣39例,腓骨肌皮瓣31例,背阔肌皮瓣8例。术后观察皮瓣成活率和并发症。结果成功164(97.6%)例,失败4例,患者出现术后早期局部并发症6.5%(11/168),术后皮瓣危象发生率为5.4%(9/168),其中静脉血栓形成66.7%(6/9),手术探查抢救成功率55.6%(5/9),前臂桡侧皮瓣成活率97.8%(88/90);股前外侧皮瓣成活率97.4%(38/39);腓骨肌皮瓣成活率96.8%(30/31);背阔肌皮瓣8例全部成活,随访2～2.5年大部分患者外形及功能满意。结论游离皮瓣修复口腔颌面部缺损的成活率高,前臂皮瓣、股前外侧皮瓣、腓骨肌(皮)瓣、背阔肌皮瓣是修复口腔颌面部缺损的常用皮瓣。     

腓骨肌皮复合组织瓣的临床手术解剖研究

了解腓骨肌皮复合组织瓣血供特点,手术实施种植义齿的可行性,为其临床应用提供临床手术解剖 基础。方法对１０例病人切取腓骨肌皮复合组织瓣以供修复下骨及周围软组织,观察腓骨肌皮复合组织瓣的（１）血供特点;（２）手术操作要点;（３）手术并发症;（４）腓骨与种植义齿的关系。     

Deep circumflex iliac artery perforator flap with iliac crest for oromandibular reconstruction

When combined with iliac bone, perforator flaps are more chimeric, and there is increased mobile skin island to reconstruct soft tissue defects in the oral and maxillofacial region. This study examined oromandibular defects reconstructed using deep circumflex iliac artery perforator flap with iliac crest (DCIAPF). We retrospectively reviewed records of 23 patients with mandibular defects received DCIAPFs after oncological resection for oromandibular reconstruction from November 2015 to August 2016. All perforators, identified before surgery by Doppler examination, were terminal perforators of DCIA. DCIAPFs were successfully harvested in all patients. The flap survival rate was 95.6% (22/23); one flap failed due to artery spasm. Three patients developed slight skinedge necrosis in the skin island. Anatomical reconstruction contour of the mandible and sufficient bone length and height were achieved, with no serious donor-site complications during the follow-up period. The results demonstrated that DCIAPF is a favorable single-flap option for oromandibular reconstruction after oncological resection with fewer donor-site complications because of its adequate bone tissue and satisfactory soft tissue, with a constant location of the perforator.     

Complications and loss of free flaps after reconstructions for oral cancer

The aim of this retrospective study was to analyse the incidence of complications and loss of flaps after primary reconstructions for oral cancer in 191 patients at our hospital over the five years 2005–2010. The patients’ clinical and personal details, characteristics of the tumours, types of microvascular flap, complications, and outcomes were recorded. The soft tissue flaps used most often were the fasciocutaneous radial forearm free flap (RFFF) (n = 86, 45%) and the anterolateral thigh free flap (ALTFF) (n = 48, 25%) while the most commonly used osseous flap was the deep circumflex iliac artery flap (DCIA) (n = 25, 13%). There were postoperative complications that required intervention in a quarter of the patients, most often in the age group 41–50 years (p = 0.018). Older age was not associated with the development of complications. The overall survival of all free flaps was 181/191 (95%), and the only significant individual predictor of loss of a flap was reconstruction with a DCIA (p = 0.016), five of the 25 of which were lost. We conclude therefore that DCIA free flaps are associated with an increased risk of failure; the method of osseous reconstruction for maxillofacial reconstruction should be selected carefully; and carefully chosen older patients do not seem to be at increased risk of morbidity.     

前臂游离皮瓣在舌癌术后组织缺损修复与功能重建中的应用

目的:总结前臂游离皮瓣在舌癌术后组织缺损修复与功能重建中的临床效果。方法:选择舌癌联合根治术+同期前臂游离皮瓣移植修复术治疗的患者39例,对临床治疗效果进行随访观察。结果:随访6个月～4年,全部病例供、受区创口均一期愈合,患者语言、吞咽等功能均满意。结论:前臂游离皮瓣修复是舌癌术后组织缺损修复与功能重建较为理想的选择。     

前臂游离皮瓣功能性修复颌面部缺损的临床体会

目的：探讨个体化设计前臂皮瓣修复领面部缺损,以期达到恢复其解剖形态和生理功能的目的。方法：选择舌癌、颊癌、口底癌患者20例,设计前臂皮瓣时,一是根据缺损大小、形状设计其皮肤外形,二是根据桡动脉和头静脉走行,设计皮下筋膜层外形,包括桡动脉和头静脉在内,大于皮肤范围。术后半个月、3个月、6个月评价修复器官的解剖形态、黏膜化程度、发音清晰度、运动及饮食类型等诸方面生理功能。结果：20例皮瓣全部获得成功,术后半个月和3个月有不同程度的皮瓣外形臃肿,6个月后．修复器官解剖形态无臃肿和牵拉,发音较清晰,感觉功能也有不同程度的恢复,大部分患者（18／20）进普食,少部分（2／20）为软食。结论：皮肤和筋膜下设计前臂皮瓣修复颌面部缺损,可以较好恢复颌面部器官的解剖形态和生理功能。     

The deep circumflex iliac artery perforator flap (DCIAP)—A reconstructive option for the large composite oro-mandibular cutaneous defect

The deep circumflex iliac artery (DCIA) flap is often used for mandibular reconstruction but it is bulky and causes additional donor-site morbidity because of the inclusion of an “obligatory internal oblique muscle”. Large composite segmental mandibular resections that consist of floor of mouth, subtotal tongue, and adjacent facial skin are a challenge in terms of reconstruction. They often require 2 free flaps or a free scapular flap and both have disadvantages. The deep circumflex iliac artery perforator (DCIAP) flap with a cutaneous component overcomes the disadvantages. We describe reconstructions with DCIAP flaps in 3 patients with large mandibular composite segmental defects. We report our experience of the flap and discuss some of the difficulties we encountered and the points we learned perioperatively.     

游离腹直肌皮瓣在口腔颌面大型缺损Ⅰ期修复中的应用

目的：探讨应用游离腹直肌皮瓣修复口腔颌面部癌术后大型缺损的可行性。方法：对18例口腔颌面部肿瘤切除术后大型缺损即刻游离移植腹直肌皮瓣修复,对临床资料进行分析和总结。结果：随访3～24个月,18例皮瓣完全成活,成活率100％。结论：腹直肌皮瓣游离移植是修复口腔颌面部大型缺损可靠和理想的方法。     

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目的探讨几种常用带蒂组织瓣行口腔软组织缺损即刻修复的可行性,比较各瓣的优缺点,并为带蒂组织瓣的选择提出建议。方法对武汉大学口腔医学院1985—2006年期间346例口腔恶性肿瘤切除后软组织缺损患者,采用单一带蒂组织瓣行即刻修复的临床资料进行回顾性分析。疗效评估包括修复部位、修复方法、组织瓣大小、手术时间、鼻饲管和气管切开术使用率、皮瓣相关并发症、皮瓣供区美学评价、住院时间及住院费用等。结果组织瓣总成功率为94.2%,其中108例带蒂组织瓣术后出现了不同程度的并发症(31.2%)。并发症发生率与术前放疗关系密切(P<0.05)。鼻饲管及气管切开术的使用率与修复部位有关。在供区美学评价中,颈阔肌皮瓣(87%)和胸锁乳突肌皮瓣(81%)具有较高的满意度。结论胸大肌皮瓣适于修复组织缺损大的口咽以及舌、口底缺损;对于早期口腔癌切除后中小型软组织缺损且术前未行放疗的患者,颈部带蒂组织瓣是一种较好的选择;而对美观要求不高,身体状况欠佳的大面积颊黏膜缺损可采用额瓣修复。     

前臂尺侧游离皮瓣在舌再造中的应用

目的：探讨用前臂尺侧游离皮瓣修复舌缺损的效果及切取皮瓣后对手功能的影响,方法：对15例舌癌术后用前臂尺侧游离皮瓣即刻修复舌缺损,术后观察成功率,舌的外形,活动度及粘膜化情况,对手术前后左右手小指及无名指的两点触觉进行比较。结果：15例用前臂尺侧游离皮瓣修复舌缺损的皮瓣全部成活,舌外形,活动度及粘膜化均满意,术前和术后双手小指和无名指二点触觉及痛觉未见明显差异,而10例桡侧皮瓣的患者中有3例半年内拇指和食指有不同程度的感觉迟钝,结论．：前臂尺侧游离皮瓣由于位置较桡侧隐蔽,质地更细腻,切取后对拇指及食指掌侧的感觉功能无影响,该皮瓣不失为舌缺损修复再造的首选皮瓣之一。     

前臂桡侧游离皮瓣修复口腔颌面软组织缺损的体会-附92例报告

目的总结用前臂桡侧游离皮瓣修复口腔颌面软组织缺损的经验。方法对我科92例应用前臂桡侧游离皮瓣修复口腔颌面软组织缺损的病例进行临床分析。结果前臂桡侧游离皮瓣具有许多符合口腔颌面部修复要求的优点,本组92例的成功率为95.7%;修复口内缺损时注意皮瓣下勿留有死腔,保持局部引流通畅,否则易导致感染发生。结论前臂桡侧游离皮瓣是一种多功能的优良皮瓣,适合修复口腔颌面部各个解剖区域的软组织缺损。     

舌瓣重建口腔软组织缺损研究进展

尽管目前口腔内软组织缺损越来越多地采用游离皮瓣修复,舌瓣如使用得当,仍不失为一种安全可靠且并发症少的修复方法,尤其适用于腭、磨牙后区、后颊、下唇唇红及舌部分切除后中等大小的软组织缺损。本文就舌瓣的解剖学基础及其在口腔内软组织缺损中的临床应用进展作一综述。     

Deep circumflex iliac artery flap combined with a costochondral graft for mandibular reconstruction

Our aim was to use the deep circumflex iliac artery (DCIA) flap together with a costochondral graft as a safe and reliable bone flap for routine reconstruction of the mandibular body and the temporomandibular joint (TMJ). Five patients with benign tumours of the mandible had segmental mandibulectomy including the condyle, and this was reconstructed in one stage using the DCIA combined with a constochondral graft. The rib was inserted into the iliac crest as a whole transplant, and fixed to the proximal stump of the mandible with a prebent reconstruction plate according to a computer-aided design. The grafts healed uneventfully, and dental implants were inserted in 4 cases. During the 2-year follow-up these patients had good mandibular function, including mouth opening, force of bite, and occlusion. The radiographs showed good bony consolidation between the graft and the stump of the mandible and function of the TMJ.A DCIA flap combined with a costochondral graft is a safe and reliable way to provide not only a large bulk of bone to suit the mandible, but also good function of the TMJ in the absence of radiotherapy.     

应用核磁共振(MRI)采集及三维重建面部表面软组织形态的研究

目的:对MRI在面部软组织的三维扫描与重建图像效果进行研究,以判断其在颌面重建领域中的应用价值。方法:对2名健康志愿者头部进行MRI扫描,扫描数据以DICOM格式储存。在诊断工作站上以SSD法对图像进行重建。结果:在扫描层厚较小的情况下,MRI能完成面部大部分软组织的三维扫描与重建,但图像质量较粗糙。结论:MRI能完成面部软组织的三维扫描与重建,但不应作为颌面重建首选的重建方式。     

下颌骨放射性骨坏死伴颌面部组织坏死的临床治疗

目的：探讨较大范围放射性下颌骨骨坏死伴颊瘘的临床手术治疗及下颌骨、面部软组织缺损的修复方法。方法：5例较大范围放射性下颌骨骨坏死,均存在暴露的坏死骨组织和颊瘘,进行下颌骨部分切除和颊部软组织切除,面部组织缺损同期应用腓骨瓣联合前臂皮瓣进行修复。下颌骨缺损平均长度65mm。结果：手术后移植的骨瓣、皮瓣成活,创口Ⅰ期愈合,面部形态及口腔功能恢复。6～12个月复查骨愈合趋正常,未见新的瘘道形成。结论：下颌骨放射性骨坏死伴面部软组织坏死应积极手术治疗,下颌骨的切除手术应在正常边缘上截骨,彻底清除病变坏死组织,方可达到疾病治愈或防止复发,同时行游离腓骨瓣联合前臂皮瓣整复面部组织缺损,能理想地恢复面部的外形及口腔功能。     

前臂游离皮瓣修复口腔颌面部大面积缺损的远期疗效观察

目的：总结用前臂游离皮瓣修复口腔颌面部软组织缺损的经验及远期疗效观察。方法：对131例前臂区游离皮瓣修复口腔颌面部软组织缺损病例进行分析，并对37例进行了0．5～18年随访。结果：本组131例成功率99．24％，共吻合动、静脉分别为131条和253条。远期随访观察供区、受区组织恢复良好，部分皮瓣恢复感觉。结论：前臂游离皮瓣是一种多功能的优良皮瓣，适合修复口腔颌面部各个区域的软组织缺损，远期疗效好。