同种异体全脸面移植供体切取和供体选择的策略研究

目的探讨同种异体全脸面移植供体切取的手术策略。方法选用12具新鲜尸体,随机分成两组,组Ⅰ采用双蒂法,组Ⅱ采用单蒂法。两组均在SMAS深层进行解剖,分别测量和记录皮瓣的获取时间,受体动脉、静脉和神经蒂的长度。术后进行换脸手术。并将组Ⅰ中的皮瓣用亚甲兰进行灌注,以了解皮瓣血运。结果组Ⅰ平均用时(46±11)min,组Ⅱ平均用时(111±7)min,P<0.01。皮瓣灌注结果示一侧颞浅动脉和对侧面动脉完全可以供应复合皮瓣的血供。血管蒂的长度足以进行吻合。术后患者的外观:既不像受者也不像供者,取决于两者的骨骼系统及软组织系统的差异。结论采用双蒂法切取同种异体全脸面皮瓣,具有操作简洁、迅速、安全、血供可靠的优点,值得在临床应用中推广。

Strategy study of harvesting total facial flap and donor choice for allograft transplantation in cadaver

OBJECTIVE: To explore the operational strategy of harvesting total facial allograft by autopsy. METHODS: Twelve fresh human cadavers were dissected. They were divided into two groups randomly. The total facial-scalp flap of the group I was elevated by the bi-pedicle method, the group II was operated with single-pedicle method. Both were dissected at the deep plane of the SMAS. : the time of facial flap harvesting, length of the artery vein and nerve pedicles of the donor were measured and marked, after operation, in each group we transferred one facial allograft to another. Then the free graft of group I was poured through artery by methylthioninium chloride to study vascular territories. RESULTS: Mean harvesting time of the group I (46 +/- 11) minutes, group II (111 +/- 7) minutes, P < 0.01. Perfusion result shows that unilateral superficial temporal artery and the opposite side of the facial artery can supply blood for whole face. The pedicle was long enough for anastomosis. Post-operation appearance: the face looks like neither the donor nor the recipient primarily, It's mainly due to the characteristics of the skeleton and the soft tissues. CONCLUSIONS: The bi-pedicle method of the harvesting total facial allograft is concise, fast, safe can be widely applied in clinical.