前臂桡侧游离皮瓣静脉回流障碍的临床观察:附13例报道

目的:探讨前臂桡侧皮瓣(radial forearm free flap,RFFF)移植术后静脉危象的临床治疗。方法:选择因口内软组织缺损接受RFFF移植修复的患者178例,回顾分析其中因静脉危象行手术探查的13例患者的临床资料。采用SPSS11.5软件包对数据进行统计学处理。结果:13例发生静脉回流障碍的病例经手术探查后,9例抢救成功,4例失败。其中,6例吻合2条静脉(失败2例),7例吻合1条浅静脉(失败2例)。除1例埋入瓣外,所有进行探查的皮瓣均出现颜色改变。4例出现皮瓣边缘渗出性出血,至皮瓣渗血停止、出现颜色变化后才进行手术探查。结论:RFFF发生危象主要是由于局部静脉回流障碍,吻合2条静脉与1条静脉相比,危象发生率与抢救失败率无显著差异。发生静脉危象时,皮瓣颜色由远及近改变,主要是由于远端静脉回流障碍所致。术后皮瓣边缘渗出性出血是静脉回流障碍的早期表现,应及时检查。静脉回流障碍时间越长,血栓范围越大,皮瓣坏死的可能性越大。     

联合应用游离腓骨瓣和前臂皮瓣修复口腔下颌骨复合缺损

目的 :分析联合应用游离腓骨瓣和前臂皮瓣在口腔下颌骨复合缺损修复中的应用价值。方法 :对2 0 0 0 0 3～ 2 0 0 2 0 1期间完成的 2 3例联合应用游离腓骨瓣和前臂瓣行口腔下颌骨缺损修复的病例作回顾性研究 ,分析缺损的类型、受区血管、游离瓣成活情况及术后并发症的发生情况 ,并分析有可能影响游离瓣成活的各种因素。结果 :2 3例患者中男性 17例 ,女性 6例 ,年龄 3 1～ 72岁 ,平均 5 2 .9岁 ,所采用的游离腓骨复合瓣中 ,腓骨长度 6～ 15cm(平均 10 .6cm) ,皮岛最大面积 12cm× 5cm ,最小 5cm× 3cm(平均 8.4cm×3 .6cm) ,腓骨的截骨次数为 0～ 3次 (平均 1.7次 ) ,所采用前臂皮瓣最大面积 10cm× 8cm ,最小 6cm× 5cm ,平均 7.8cm× 6.4cm。 2 3例患者的 46块游离瓣全部获得成活 ,受区和供区总的并发症发生率为3 0 .4% ,但并发症均不严重 ,没有造成严重的后果。结论 :游离腓骨瓣和前臂皮瓣联合应用在大型口腔下颌骨复合缺损的修复中具有较大的灵活性 ,安全可靠 ,并能较好地恢复患者的外形和功能 ,提高了患者的生存质量     

Numerical simulations of different configured venous anastomosis in microvascular flap transfer

Background

Free flap surgery is a well-established method for covering large defects in the head and neck region. Most cases of flap failure are caused by venous thrombosis. Thus, there is a lot of discussion about the ideal design of venous anastomosis and its impact on the hemodynamics in the vessels. This study concentrates on the simulation of flow patterns of different designs of venous anastomoses.

Posterior tibial artery flap versus radial forearm flap in oral cavity reconstruction and donor site morbidity

The repair of soft tissue defects after oral cavity cancer resection is challenging. The aim of this study was to compare the outcomes and donor site morbidity of the radial forearm free flap (RFF) and posterior tibial artery perforator flap (PTAF) for oral cavity reconstruction after cancer ablation. All patients who underwent oral cavity reconstruction with a RFF or PTAF between January 2017 and December 2019 were included retrospectively in this study. All flaps were harvested with a long adipofascial extension. The donor site defects were closed with a triangular full-thickness skin graft harvested adjacent to the flap. Flap outcomes and donor site complications were recorded and compared. The study included 145 patients; 30 underwent reconstruction with a RFF and 115 with a PTAF. No significant difference between the PTAF and RFF was observed concerning the flap survival rate (98.3% vs 96.7%), flap harvest time (53.39 vs 49.28 min), hospital stay (12.3 vs 15.2 days), or subjective functional and cosmetic outcomes. The PTAF showed a larger vascular calibre (P < 0.05), greater flap thickness (P = 0.002), and lower frequency of surgical site infection (P = 0.055) when compared to the RFF. No significant difference was observed between the pre- and postoperative ranges of ankle and wrist movements. The PTAF is an excellent alternative to the RFF for the repair of oral cavity defects, with the additional advantages of a well-hidden scar on the lower extremity, larger vascular calibre, and lower frequencies of postoperative donor site morbidities.     

前臂游离皮瓣行颌面部组织缺损修复术11O例

目的 :总结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 110例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 :前臂桡侧游离皮瓣修复口腔颌面部各类软组织缺损 110例 (硬软腭缺损修复再造 3例 ) ,其中 1例为双前臂桡侧游离皮瓣。 10 5例全部存活 (尿毒症伴舌癌患者 1例 ) ,1例大部份存活 ,成功率 96.4% ,失败 4例。结论 :前臂桡侧游离皮瓣解剖恒定、制备方便 ,厚薄适中、便于折叠、血管蒂长 ,是一种修复口腔颌面软组织缺损的优良皮瓣 ,也是口腔颌面部软组织缺损修复的首选皮瓣     

Comparison between the radial forearm and superficial circumflex iliac artery perforator free flaps for oral soft tissue reconstruction

The radial forearm free flap (RFFF) is widely used for oral reconstruction. The superficial circumflex iliac artery perforator (SCIP) flap is an increasingly utilized alternative. The cases of 165 patients who received either an RFFF or SCIP flap for oral reconstruction at Chris O′Brien Lifehouse, Sydney were reviewed. The aim was to report on patient, pathology, treatment, and outcome variables and to compare these between the two flap groups. A RFFF was used in 126 patients and a SCIP flap in 39 patients. SCIP flap patients were younger (P < 0.001) and had shorter operative times (P < 0.001), shorter anaesthetic times (P < 0.001), and more frequent recipient site dehiscence (P = 0.005) when compared to RFFF patients. The SCIP flap was significantly less frequently used for composite resections including bone when compared to the RFFF (P < 0.001). The primary site distribution was more even for RFFF patients (P < 0.001). There were no SCIP flap failures; three RFFF failures occurred. SCIP flaps performed comparably in terms of operative and clinical outcomes. Most SCIP flaps were utilized in younger patients with partial glossectomy defects.     

超声刀在前臂皮瓣制备术中的应用研究

目的探讨超声刀在前臂皮瓣制备术中的应用及疗效评价。方法 2014年8月至2015年12月在南京医科大学附属口腔医院行前臂皮瓣修复口腔组织缺损的患者26例,随机分为两组,每组13例,试验组运用超声刀制备,对照组运用普通手术刀制备,分析两组患者手术时间、术中出血量及术中术后并发症发生情况。结果术后前臂皮瓣全部存活,试验组手术时间少于对照组(P<0.05),试验组术中出血少于对照组(P<0.05)。两组均未出现并发症。结论运用超声刀行前臂皮瓣制备术可以缩短手术时间、减少手术中出血量,可在临床推广应用。     

Free radial forearm flap and anterolateral thigh flap for reconstruction of hemiglossectomy defects: A comparison of quality of life

Objectives

The purpose of the retrospective study was to compare the differences of quality of life (QOL) outcomes 2 or more years postoperatively between the free radial forearm flap (FRFF) and anterolateral thigh flap (ALTF) in reconstruction of defects of a hemiglossectomy.

前臂皮瓣修复舌缺损感觉功能恢复的研究

目的:观察非感觉性游离桡侧前臂皮瓣修复舌缺损术后感觉功能的恢复情况。方法:追踪65例舌癌扩大切除同期行游离前臂皮瓣修复术患者,术后6～12个月复查,检测皮瓣的触觉、两点辨别觉、痛觉(钝锐觉)、方向觉和冷热觉的恢复情况。结果:29例皮瓣(44.6%)至少3/4面积有感觉恢复,32例皮瓣(50%)有部分感觉恢复,4例皮瓣(6.3%)无感觉恢复。结论:非感觉性游离前臂皮瓣修复舌缺损后可自行恢复感觉功能。放疗可能减缓甚至阻碍皮瓣感觉功能的恢复。     

Use of a titanium cutting guide to assist raising the composite radial forearm free flap

The use of composite radial free tissue transfer has been overtaken by other composite flaps. This is due to donor site morbidity and the poor volume of bone yielded. The advantages and potential complications of composite radial flaps are well described. Use of the composite radial forearm free flap has been largely superseded in mandible reconstruction, but applications such as a salvage option still exist. Additionally it may be used in the reconstruction of midface defects. The use of a cutting guide to reduce the donor site complications and yet produce a maximal yield of bone is described herein. With the use of a skilled maxillofacial laboratory, the planning allows precise cuts and placement of the free flap and allows accurate prophylactic plating of the radius. A precise titanium cutting guide and custom distal radius plate are used. Details of three cases where these techniques have been implemented are described. The paper demonstrates the significant advantages of using laboratory-based technology to assist in performing composite radial free flaps. This paper reveals that composite radial free tissue transfer still has a place in the reconstruction of very selective defects of the head and neck. In particular, its use in reconstruction of Class 5 and 6 maxillary defects (Brown classification) is illustrated. Correct case selection and planning results in increased confidence to use this flap.     

35例股前外侧游离皮瓣血管危象临床分析

目的:总结分析股前外侧游离皮瓣术后血管危象发生的可能原因,探讨影响股前外侧游离皮瓣移植成功率的因素,为进一步提高皮瓣移植成功率提供参考.方法:回顾2005年9月-2012年12月中南大学湘雅二医院口腔颌面外科行股前外侧游离皮瓣移植修复的患者,记录皮瓣危象发生的时间、危象类型及抢救结果.计算皮瓣移植成功率、皮瓣危象发生率、危象抢救成功率等.应用SPSS 16.0软件包对数据进行x2检验或Fisher精确检验.结果:812块股前外侧游离皮瓣移植成功率为97.8％ (794/812).发生血管危象者35块,抢救成功17块,坏死18块.35块发生血管危象的皮瓣中,静脉危象31块(88.6％)、动脉危象4块(11.4％).术后16h内皮瓣抢救成功率显著高于术后16h以后的抢救成功率(70.6％:27.8％,P=0.011),静脉危象的抢救成功率高于动脉危象的抢救成功率(51.6％:25.0％,P=0.316),但差异无显著性.穿支血管受损是导致股前外侧皮瓣危险的重要原因之一.结论:早期发现并及时手术探查是提高皮瓣危象抢救成功率最有效的方法.针刺出血试验是目前判断皮瓣危象发生与否及危象类型最准确的临床观察方法.也是目前判断皮瓣危象发生与否及危象类型的金标准.     

基底细胞痣综合征手术治疗同期前臂皮瓣转移修复1例报告

本文报告1例男性基底细胞痣综合征患者,30岁,全麻下行颌骨多发囊肿切除术、下颌软组织及骨组织扩大切除术,同期使用前臂游离皮瓣移植,修复下颌皮肤及口腔黏膜缺损,术后恢复良好。     

Ӧ��ǰ��Ƥ���޸�ȫ��ȱ��2��

鼻位于面中1/3,在人的面部处于明显的位置,所以轻微的缺损或畸形会对人的外貌和心理产生较大的影响。鼻部缺损多由车祸、咬伤、炸伤和烧伤、感染、肿瘤切除造成     

Total nasal reconstruction using composite radial forearm free flap and forehead flap as a one-stage procedure with minor revision

The refashioning of the many distinct structures necessary for successful anatomical and aesthetic reconstruction of the nose after total rhinectomy is difficult. Several significant operations are needed to produce good aesthetic results with functional patency of the nasal airway. We describe a method using autologous grafts that has produced good results on both occasions when it was done. It has the advantage of only one major operation and one subsequent minor revision.     

Hand perfusion following radial or ulnar forearm free flap harvest for oral cavity reconstruction: A prospective study

The radial forearm free flap (RFFF) and ulnar forearm free flap (UFFF) are used in head and neck reconstruction because they provide a thin and pliable skin paddle as well as a long vascular pedicle. However, in spite of several studies showing the safety of the UFFF, the RFFF is more popular among reconstructive surgeons based on concerns about hand ischaemia. A prospective study was designed in which 10 UFFF and 11 RFFF surgeries were performed in 20 patients undergoing oral cavity reconstruction between January 2017 and July 2018. Hand vascular parameters were evaluated preoperatively and postoperatively using Doppler ultrasound and plethysmography. The preoperative and postoperative diameters of the radial and ulnar arteries, and the flow velocities through the remainder of the forearm artery were measured preoperatively and at 3 months postoperative. Additionally, a comparison was performed between the preoperative and postoperative fingertip perfusion values according to impedance plethysmography. The preoperative mean diameter of the radial artery (2.89 ± 0.47 mm) was significantly greater than that of the ulnar artery (2.35 ± 0.48 mm) at the level of the wrist; however, 3 months after the surgery, the mean diameters of the two arteries did not differ significantly. There were no differences in digital perfusion when a UFFF was used compared with an RFFF.     

Retrospective comparison of split-thickness skin graft versus local full-thickness skin graft coverage of radial forearm free flap donor site

The study aimed at comparing outcomes between split-thickness skin graft (STSG) and local ipsilateral full-thickness skin graft (FTSG) after radial forearm free flap defect closure.A comprehensive study protocol for objective and subjective assessment was established for this retrospective, single-center study. Clinical examinations were carried out, encompassing measuring wrist and finger range of movement and grip strength, testing skin sensitivity, and evaluating aesthetics using the Patient and Observer Scar Assessment Scale (POSAS). In addition, medical history, and questionnaire, including Cold Intolerance Severity Score (CISS) and 18 items, were used to assess satisfaction, functional limitations, and complaints.44 patients were examined, and 40 patients included, who had received STSG (group 1; n = 19) respectively local FTSG from the ipsilateral forearm (group 2; n = 21) at least three months previously. Significantly lower values for parameters pigmentation, relief (p = 0.015), overall impression (p = 0.044), as well as mean POSAS observer scale total score (p = 0.046) and no complaints wearing a wristwatch (p = 0.012) were shown in group 2 (FTSG).Within the limitations of the study, it seems that FTSG harvested from the forearm should be preferred over STSG to cover RFFF donor site whenever appropriate, because of beneficial outcomes, while providing single intervention closure and avoiding secondary donor site.     

Accurate occlusion-driven maxillary reconstruction with deep circumflex iliac artery flap using computer-assisted techniques and intraoral anastomosis: a case series

The aim of this study was to evaluate the feasibility and accuracy of occlusion-driven maxillary reconstruction with the deep circumflex iliac artery (DCIA) flap, using computer-assisted design and manufacturing (CAD/CAM) technology and intraoral anastomosis. The data of 11 patients who underwent occlusion-driven maxillary reconstruction with this method between December 2018 and December 2020 in the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology were reviewed retrospectively. Postoperative complications and functional and aesthetic outcomes were recorded. The accuracy of the postoperative restoration was assessed using Geomagic Control 2014. Reconstruction was successful in nine patients; all were satisfied with their aesthetic and functional outcomes. One patient underwent extraoral anastomosis after failure of intraoral anastomosis. In another patient, the DCIA flap had to be removed after the operation because of flap failure. Among the 10 patients with DCIA flap success, colour map analysis showed a mean deviation of 0.40 ± 0.08 mm between the preoperative and postoperative craniomaxillary models. Thus, occlusion-driven maxillary reconstruction with the DCIA flap, using CAD/CAM technology and intraoral anastomosis, appears to be a feasible and accurate method for the repair of maxillary defects.