游离背阔肌肌瓣充填修复半侧颜面萎缩

目的探讨游离背阔肌肌瓣充填修复半侧颜面萎缩的效果。方法术前石膏倒模，根据石膏模型设计右侧游离背阔肌肌瓣并进行移植填充，矫正半侧颜面萎缩。肌瓣上于蒂部旁携带1cm×2cm大小皮肤，缝于下颌角前缘切口，以便术后观察血运。胸背动、静脉分别与面动脉、面前静脉吻合，术后常规抗血栓、抗痉挛、抗感染等治疗。结果两例肌皮瓣均成活。术后下颌（即蒂部）稍显臃肿，一例鼻唇沟填塞组织稍有外移、下坠，3个月后再次手术修复后效果满意。结论准确的组织瓣设计和塑形、可靠的血管显微吻合、良好的组织瓣固定是游离组织瓣充填修复半侧颜面萎缩手术成功的三个关键．     

应用游离股前外侧脂肪筋膜瓣矫治半侧颜面萎缩的临床研究

目的探讨应用股前外侧脂肪筋膜瓣游离移植矫治半侧颜面萎缩的临床效果。方法1997年1月～2006年5月，应用以吻合血管的股前外侧脂肪筋膜瓣游离移植，部分加以Medpor植人及二期手术修整，矫治半侧颜面萎缩患者35例。男11例，女24例；年龄15～47岁。左侧12例，右侧23例。病程4～28年。患者半侧颜面畸形较严重，面颊部凹陷明显。X线片及三维CT重建检查见28例患侧骨骼发育不良。切取脂肪筋膜瓣范围8cm×7cm～20cm×11cm。供区直接缝合。结果术后患者伤口均I期愈合，脂肪筋膜瓣全部成活，供区切口愈合良好，无脂肪液化。35例均获随访6个月～8年。面部轮廓形态满意，双侧基本对称，供区无明显功能障碍。结论吻合血管的股前外侧脂肪筋膜瓣可提供充足的组织量，成活率高，供区隐蔽，不牺牲重要血管，辅以相应的非生物材料及治疗手段，可使半侧颜面萎缩得到满意矫治。     

游离背阔肌肌瓣联合自体脂肪填充序列治疗修复半侧颜面萎缩

目的:探讨游离背阔肌肌瓣联合自体脂肪填充序列治疗修复半侧颜面萎缩的效果。方法:对9例半侧颜面萎缩患者,采用I期行游离背阔肌肌瓣移植,于术后0.5～1年行Ⅱ期自体脂肪填充术。根据面部对称情况行1～3次自体脂肪填充,观察其临床效果。结果:9例肌瓣全部成活,术后0.5～1年观察肌瓣轻度下垂,可见局限性凹陷。经1-3次自体脂肪填充后面部外观明显改善,对称性良好,供区无明显功能障碍。结论:游离背阔肌肌瓣联合自体脂肪填充序列治疗是矫治中、重度半侧颜面萎缩的较好选择,结合不同手术特点的综合治疗,能够显著提高中、重度半侧颜面萎缩的治疗效果。     

腹腔镜下取大网膜游离移植矫治严重的半侧颜面萎缩

目的 介绍在腹腔镜下取大网膜游离移植矫治严重的半侧颜面萎缩的手术方法。对骨骼萎缩明显者，加用Medpor假体进行颧骨塑形，恢复和重建颜面的形态和丰满度。方法 在腹腔镜下解剖游离胃网膜动脉并结扎切断，将大网膜经腹腔镜拉出体外，游离移植于患侧面部，与受区周围的动静脉吻合。辅加Medpor假体复合填充治疗严重的半侧颜面萎缩。结果本组6例患者，游离移植大网膜全部成活，无并发症发生。术后随访8个月至2年，效果满意。结论 腹腔镜下取大网膜做吻合血管游离移植，修复严重的半侧颜面萎缩，其外观形态及丰满度较好，并发症少，是目前行之有效的方法之一。     

游离股前外侧筋膜脂肪瓣联合人脱细胞异体真皮重塑半侧颜面萎缩畸形

目的:探讨游离股前外侧筋膜脂肪瓣联合人脱细胞异体真皮修复半侧颜面萎缩畸形的效果。方法:2008年1月至2020年12月,北京协和医院整形美容外科收治各种原因所致半侧颜面萎缩患者19例,男3例、女16例,年龄16~56(29±10)岁。一期手术根据半侧颜面萎缩范围设计获取游离股前外侧筋膜脂肪瓣,与面部血管显微吻合后填充入...     

腹腔镜下取大网膜游离移植矫治严重的半侧颜面萎缩

目的介绍在腹腔镜下取大网膜游离移植矫治严重的半侧颜面萎缩的手术方法。对骨骼萎缩明显者,加用Medpor假体进行颧骨塑形,恢复和重建颜面的形态和丰满度。方法在腹腔镜下解剖游离胃网膜动脉并结扎切断,将大网膜经腹腔镜拉出体外,游离移植于患侧面部,与受区周围的动静脉吻合,辅加Medpor假体复合填充治疗严重的半侧颜面萎缩。结果本组6例患者,游离移植大网膜全部成活,无并发症发生。术后随访8个月至2年,效果满意。结论腹腔镜下取大网膜做吻合血管游离移植,修复严重的半侧颜面萎缩,其外观形态及丰满度较好,并发症少,是目前行之有效的方法之一。     

自体真皮脂肪瓣游离移植矫治半侧颜面萎缩

目的 探讨应用自体真皮脂肪瓣游离移植矫治半侧颜面萎缩的临床价值.方法 自体真皮脂肪瓣均取自下腹及髂腰部,切取范围为5 cm×11 cm～7 cm×20 cm.切取后游离移植,并配合Med-por假体植入、健侧下颌角外板截除移植于患侧、皮肤软组织扩张术、自体脂肪颗粒游离移植等方法,自2004年5月至2008年5月,对15例半侧颜面萎缩患者进行综合矫治.供区直接缝合.结果 术后近期除1例患者出现部分脂肪液化经换药治疗愈合外,余者伤口均Ⅰ期愈合;随访15例患者6个月至4年,面部外形基本对称,效果较满意.结论 半侧颜面萎缩应根据病情采用适当的方法进行矫治.自体真皮脂肪瓣具有供区组织量充足、成活率较高、供区隐蔽、切取操作简单等优点,值得临床上推广应用.     

游离肩胛脂肪筋膜瓣修复单侧颜面萎缩临床研究

目的：探讨游离肩胛脂肪筋膜瓣修复单侧颜面萎缩的远期疗效。方法：设计以旋肩胛动脉与伴行静脉血管为血管蒂的游离肩胛脂肪筋膜瓣填充移植于颜面萎缩部修复颜面外形，血管蒂与受区颞浅动静脉吻合。结果：临床应用12例均获成功，随访1～7年，脂肪筋膜瓣萎缩量约5％～10％，最大萎缩量为20％，外形基本满意。结论：带血管蒂游离脂肪瓣筋膜移植可获得较长期稳定的手术效果。术前设计仍应适当考虑脂肪筋膜瓣远期萎缩因素。     

游离股前外侧筋膜脂肪瓣联合人脱细胞异体真皮重塑半侧颜面萎缩畸形

目的探讨游离股前外侧筋膜脂肪瓣联合人脱细胞异体真皮修复半侧颜面萎缩畸形的效果。方法 2008年1月至2020年12月, 北京协和医院整形美容外科收治各种原因所致半侧颜面萎缩患者19例, 男3例、女16例, 年龄16～56(29±10)岁。一期手术根据半侧颜面萎缩范围设计获取游离股前外侧筋膜脂肪瓣, 与面部血管显微吻合后填充入凹陷部位。二期手术对皮瓣进行修整并根据面部亚单位凹陷情况用人脱细胞异体真皮填充。结果 19例患者皮瓣存活良好, 但均出现不同程度的面部亚单位组织萎缩, 主要表现在眶下、鼻唇沟、颞部等部位, 用脱细胞异体真皮填充修复, 经1～8年随访填充效果较好, 无明显排异反应。19例患者中18例出现不同程度皮瓣肥厚, 经常规吸脂或皮瓣修薄手术改善。随访1～8年, 19例患者恢复较好。结论人脱细胞异体真皮能弥补游离股前外侧筋膜脂肪瓣矫正半侧颜面萎缩的局限性, 二者联合使用能够达到更好的治疗效果, 值得临床应用。     

前锯肌下部肌瓣游离移植修复足踝部创面二例

2 0 0 2年 10月～ 2 0 0 3年 2月 ,我科采用吻合血管的前锯肌下部肌瓣游离移植修复足踝部严重软组织损伤 2例 ,均成活 ,功能佳。报告如下。1　临床资料本组 2例。男 1例 ,2 8岁 ;女 1例 ,16岁。均系外伤后足背内踝部软组织损伤 ,无合并伤。伴胫后动脉、神经、足背动脉及大隐静脉挫灭。肌腱及骨组织外露 ,软组织缺失范围 7～ 8cm×11～ 13cm。在清创、骨折内固定和有效控制感染后 ,于伤后 10～ 14天内行肌瓣移植术。经腋后线及背阔肌前缘切开 ,将背阔肌向后外牵开 ,可见胸背动静脉 ,确认发向下前锯肌的分支 ,将胸背动静脉向近侧游离至所需…     

Lengthening the pedicle of a scapular osseous free flap by angular branch reconnection within the subscapular artery system

This report describes a case of a patient who underwent secondary reconstruction of the maxilla using a combined scapular osseous and thoracodorsal artery perforator (TAP) flap, in which the pedicle of the scapular osseous flap was lengthened by reconnecting the angular branch of the thoracodorsal artery to the serratus branch. The patient was a 62‐year‐old man who had undergone left total maxillectomy for maxillary carcinoma and came for reconstruction of left deformity. A reconstructive procedure involving a vascularized scapular osseous and TAP flap transfer was planned. However, the patient's ipsilateral superficial temporary artery and facial artery was found stenosed due to previous radiotherapy and chemotherapy and were not suitable for use as recipient vessels. Thus, a long flap pedicle was needed for anastomoses to the contralateral recipient vessels. We lengthened the pedicle of the scapular osseous flap by reconnecting the angular branch of the thoracodorsal artery to the serratus branch within the chimeric free flap and then anastomosed it to the contralateral facial vessels. The postoperative course was uneventful, and the left cheek deformity was well corrected. Using the technique of reconnection of branches within the blood supply system, a chimeric flap with a long pedicle may be elevated safely whilst avoiding the need for vein grafts. © 2014 Wiley Periodicals, Inc. Microsurgery 34:662–665, 2014.     

吻合血管的游离组织瓣修复进行性单侧面萎缩症

目的用游离的股前外侧筋膜脂肪瓣充填修复进行性单侧面萎缩症。方法设计以旋股外侧动脉降支为血管蒂的游离股前外侧筋膜脂肪瓣或旋肩胛血管为血管蒂的肩胛真皮脂肪瓣，切取筋膜脂肪瓣或真皮脂肪瓣后将其转移至面部萎缩处，然后将旋股外侧动脉降支或旋肩胛血管和面动静脉相吻合。结果临床治疗8例，其中应用股前外侧筋膜脂肪瓣7例，肩胛真皮脂肪瓣1例，组织瓣全部成活，矫正的患侧面部形态与健侧基本对称，外形满意。结论游离组织瓣移植，尤其以旋股外侧动脉降支为血管蒂的股前外侧筋膜脂肪瓣能提供足够的组织量，是修复进行性单侧面萎缩症较好的方法。     

Microvascular reconstruction of nasal ala using a reversed superficial temporal artery auricular flap.

Microsurgical technique allows successful transfer of an auricular flap in a one-stage procedure, using the root of the helix. Although a free composite auricular flap with the superficial temporal artery pedicle provides a good solution to repair nasal defects, its vascular pedicle is so limited that a vein graft from other area of the body is usually needed to reach the recipient site, leaving an unpleasant scar on the donor site. The authors present a reversed superficial temporal artery auricular free flap for alar reconstruction by microsurgical transfer. This technique has been performed on four patients with posttraumatic alar defects. In three patients, the reversed superficial temporal vessels of the flap were anastomosed directly with the recipient facial vessels in the nasolabial fold. In one patient, the reversed superficial temporal artery of the flap was anastomosed with the facial artery as above, its accompanying vein to the proximal stem of the superficial temporal vein by a graft taken from the excess length of the reversed superficial temporal artery pedicle because a suitable vein was not found for microvascular anastomosis in the nasolabial area. In these four patients, the size of the flap was 2.5 x 2.0-4.0 x 2.5 cm, the length of the vascular pedicle is 5-8 cm, average 6.5 cm. The reversed superficial temporal artery auricular flap offers a long vascular pedicle of the auricular free flap for microvascular anastomosis in the reconstruction of the ala of nose, delivers a good solution to the problem of the vascular pedicle shortage of the proximal superficial artery auricular flap. There is no need of vein graft from other parts of the body because the superficial temporal vessels on the temple provide not only the flap pedicle but also a source of vessel grafts. This technique may have even wider applications in other facial cutaneous defect.     

One‐stage reconstruction by dual‐innervated double muscle flap transplantation with the neural interconnection between the ipsilateral masseter and contralateral facial nerve for reanimating established facial paralysis: A report of 2 cases

The authors developed a one‐stage double‐muscle reconstruction technique for facial paralysis using a latissimus dorsi (LD) flap and a serratus anterior (SA) flap, which were dually reinnervated by the contralateral facial nerve (FN) and ipsilateral masseter nerve (MN). The procedure was performed for 61‐year‐old man 3‐years after resection of a malignant tumor and a 24‐year‐old woman 10‐years after temporal fracture with facial paralysis. A double‐muscle flap comprising left LD and SA flaps was harvested, a 15‐cm thoracodorsal nerve (TN) section was attached to the LD flap, and 5‐cm and 1‐cm sections of the long thoracic nerve (LTN) were attached to the proximal and distal sides of SA flap. The LD flap and SA flap were sutured along the direction of motion of the zygomaticus major and risorius muscles, respectively. The contralateral FN and ipsilateral MN were interconnected by nerve suturing: the medial branch of TN to the distal end of LTN, the proximal end of LTN to the ipsilateral MN, and the buccal branch of contralateral FN to the main trunk of TN. After surgery, good contraction of the transferred flaps resulted in reanimation of a natural symmetrical smile; no complications were observed during the 12‐month follow‐up period.     

背阔肌游离皮瓣修复面颈部瘢痕挛缩畸形

目的:研究背阔肌游离皮瓣在修复面颈部挛缩畸形中所起的重要作用。方法:10例面颈部瘢痕彻底松解后,采用游离的背阔肌肌皮瓣治疗,将胸背动静脉分别与面动静脉吻合,供瓣区采用中厚皮片移植,其中两例采用预扩张的背阔肌游离皮瓣进行修复。结果:9例背阔肌肌皮瓣游离移植后完全存活,1例背阔肌皮瓣远端部分坏死,术后患者的面颈部功能和外形得到明显的改善。结论:背阔肌游离皮瓣修复面颈部瘢痕挛缩畸形效果可靠。     

Dorsal hand coverage with free serratus fascia flap

In reconstructing a defect on the dorsum of the hand, with the extensor tendons exposed or even missing, functional, as well as cosmetic, goals are of major importance. The authors present three cases of extensor tendon reconstruction, combined with soft-tissue reconstruction, with the free serratus fascia flap, the connective tissue over the serratus muscle, for dorsal hand coverage. The flap consists of thin and well-vascularized pliable tissue, with gliding properties excellent for covering exposed tendons. It is based on the branches of the thoracodorsal artery, which are raised in the flap, leaving the long thoracic nerve intact on the serratus muscle. Coverage of the flap with split-thickness skin graft is done immediately. The free serratus fascia flap is an ideal flap for dorsal hand coverage when the extensor tendons are exposed, especially because of low donor-site morbidity.     

游离胸背动脉穿支皮瓣桥式移植修复小腿软组织缺损

目的总结游离胸背动脉穿支皮瓣或肌瓣桥式移植修复小腿软组织缺损的临床应用效果。方法自2006年9月至2009年1月,应用游离胸背动脉穿支皮瓣或肌瓣桥式移植修复小腿软组织缺损11例,缺损范围4cm×8cm至8cm×22cm。皮瓣切取连带肩胛下与旋肩胛血管,血管蒂呈T形,与健侧小腿胫后动脉行端端吻合,血管蒂用中厚网状游离植皮覆盖。结果除1例术后皮瓣远端发生小的表浅感染,经换药后愈合外,本组皮瓣全部成活。术后随访9个月至3.6年(平均2.9年),没有发现明显的供区功能障碍,供区与受区外形较好,健侧小腿经临床观察与Doppler检查,胫后动脉通畅。结论本方法适用于修复四肢软组织缺损后,患者仅存1条主要动脉者;行桥式游离胸背动脉穿支皮瓣或肌瓣移植不损伤健侧小腿胫后动脉,降低了对供区的损伤。     

Total phalloplasty using a musculocutaneous latissimus dorsi flap

OBJECTIVE: To present total phalloplasty in children and adults using a musculocutaneous latissimus dorsi (MLD) free flap to create a large neophallus, that allows easy urethroplasty and implantation of a prosthesis. PATIENTS AND METHODS: From April 1999 to January 2006, 16 patients (mean age 24 years, range 10-34) had a total phalloplasty; the indications were congenital anomalies of the penis in 12, iatrogenic in two and accidental penile trauma in two. The MLD flap is mobilized on a subscapular artery and vein, and a thoracodorsal nerve. The neophallus is created on-site and after dividing the neurovascular pedicle, transferred to the pubic region, where it is anastomosed with the femoral artery, saphenous vein and ilio-inguinal nerve. The donor site was closed directly in 15 patients while in one a split-thickness skin graft was used to cover the defect. In the following stages, two- or three-stage buccal mucosa urethroplasty was used in 11 patients; a penile prosthesis was implanted in seven. RESULTS: The mean (range) follow-up was 31 (12-74) months; the penis was 14-18 cm long and 11-15 cm in circumference. There was no partial or total flap necrosis; the donor site healed satisfactorily in 13 patients while in the remaining three there was moderate scarring. The patency of the urethra was good in all patients. Two urethrocutaneous fistulae developed; one closed spontaneously and the other was successfully treated with minor surgery. The function of the implanted penile prostheses was satisfactory in all patients. CONCLUSIONS: The MLD flap allows the creation of a neophallus of good size and with a good aesthetic appearance; it allows urethroplasty and safe implantation of a penile prosthesis, and it can also be used in children.     

Foot reconstruction using a serratus anterior muscle flap from the same donor site after failure of a thoracodorsal artery perforator flap

The free flap failure rate for the lower extremities is high, which adversely affects limb salvage efforts. In this article, we report a case of failure of a thoracodorsal artery perforator flap, which was simultaneously reconstructed with a serratus anterior muscle flap from the same donor site. A 56‐year‐old male patient had infected wound for 3 months due to Achilles tendon rupture. We reconstructed the defect using a thoracodorsal artery perforator flap. However, 2 days after the operation, we found the congested flap. We were obliged to discard the whole flap and harvested a serratus anterior muscle flap from the same donor site. The patient's foot healed uneventfully. After flap failure, the use of a second free flap from the same donor site may be an effective and safe procedure in specific cases. © 2013 Wiley Periodicals, Inc. Microsurgery 34:153–156, 2014.     

Split thoracodorsal nerve funicular graft combined with functional latissimus dorsi musculocutaneous flap transfer for immediate facial reanimation after tumor ablation

The authors report a case of immediate facial reanimation resulting from functional latissimus dorsi musculocutaneous flap transfer and funicular grafting of the thoracodorsal nerve after cheek tumor ablation. After wide excision of the tumor, including the facial nerve except the temporal branch and part of the zygomatic major muscle and masseter muscle, the authors reconstructed the cheek skin and provided movement by performing a small-segment latissimus dorsi musculocutaneous flap transfer using Harii's method and the defect of the buccal and marginal mandibular branches of the facial nerve by funicular grafting from one of the two funicles of the thoracodorsal nerve. After 6 months, the transplanted, small-segment latissimus dorsi muscle showed good voluntary movement, and the lower orbiculus oris and depressor oris presented good functional recovery. The authors believe the two funicles of the thoracodorsal nerve can be used independently for two purposes: one for functional segmental muscle transfer and the other for nerve grafting to defects of branches of the facial nerve. This concept makes it possible to reconstruct multiple facial movements while minimizing donor site morbidity by means of immediate facial reanimation.