游离背阔肌肌皮瓣在口腔颌面外科的应用

目的　背阔肌肌皮瓣多以带蒂方式用于口腔颌面部软组织缺损的修复,但有一定缺点。本文论述了游离背阔肌肌皮瓣在口腔颌面外科应用的有关问题。方法　我科自1981年以来,所用游离背阔肌肌皮瓣均以胸背血管为蒂,切取肌皮瓣后,创面均直接拉拢缝合,未行植皮。不能直接拉拢关闭者,创面减张缝合后,覆以碘仿纱条,任其二期愈合。结果　应用游离背阔肌肌皮瓣修复口腔颌面部各类缺损45例,成功41例,成功率为91.1%。结论　游离背阔肌肌皮瓣提供的软组织量充足,适用于口腔颌面部某些大型缺损的修复。也可一分为二,修复面部贯通缺损。其缺点是术中需变换病人体位,不利于两组人员同时操作,故应用受到一定限制

THE USE OF LATISSIMUS DORSI MYOCUTANEOUS FLAP IN ORAL AND MAXILLOFACIAL RECONSTRUCTION

Purpose This article describes the surgical procedure of free LDF and discusses its application in OMS. Methods From 1981, the free LDP used in our department was based on the thoracodorsal vessel. The donor site was apposed primarily after harvest of the LDP with no skin graft. For donor sites that were not closed directly, iodoform gauzes were used to cover the defects and the wounds healed secondarily. Results The free LDF was used in 45 patients for reconstruction of various oral and maxillofacial defects. 41 flaps survived well and 4 flaps failed, with a success rate of 91.1%. Conclusions The free LDF can provide sufficient soft tissues which is suitable for reconstructing certain major OM defects. The flap can be divided into two harves for repair of full thickness defects. The main disadvantage of this flap is the need of changing the patient's posture intraoperatively, which does not facilitate a simultaneous work by two teams and limits its wide use in OMS.