游离血管化复合组织瓣在口腔颌面部严重创伤性缺损畸形整复中的应用：11例临床分析

目的:探讨口腔颌面部严重创伤性缺损的显微重建特点及游离血管化组织瓣的临床应用效果。方法:回顾性分析福建医科大学附属第一医院口腔颌面外科2005—2018年收治的11例外伤致口腔颌面部组织严重缺损患者,均为复合型组织缺损,累及多个解剖区域（唇、颊、鼻、耳、颞部、颌骨等）,陈旧性损伤患者尚伴有严重的瘢痕形成及组织移位。全部病例采用游离血管化组织瓣进行修复,其中前臂皮瓣4例,腓骨肌皮瓣3例,侧胸皮瓣1例,股前外侧皮瓣3例。结果:11例患者均得到有效治疗,术后随访1~13 a,游离血管化组织瓣存活率100%。未发生皮瓣危象等并发症,10例患者对修复后面部外形和功能表示满意。结论:头颈外伤性缺损具有特殊性,显微外科技术在外形修复和功能重建中具有重要作用,尤其在局部邻近组织瓣无法完成修复的大型缺损中。精准评估伤情及软、硬组织缺损严重程度,选择合适的游离血管化组织瓣,是应用该技术取得良好疗效的关键。

Reconstructing severe traumatic oro-maxillofacial defects and deformities with free vascularized composite tissue flaps:clinical analysis of 11 consecutive cases

PURPOSE:To explore the microscopic features and effect of severe traumatic oro-maxillofacial defects with free vascularized flaps.METHODS:A retrospective analysis was performed in 11 consecutive cases with severe traumatic oro-maxillofacial defects from 2005 to 2018,all patients had compound tissue defects,which involved multiple anatomical regions(for example:lip,cheek,nose,ears,tempus,jaws,etc).Meanwhile,long-standing traumatic patients had severe scars and tissue displacement.All cases were reconstructed with free vascularized flaps by using microvascular surgical technique,which included 4 forearm flaps,there fibular osteocutaneous flaps,one lateral thoracic flap,and 3 anterolateral thigh flaps.RESULTS:Eleven patients were treated effectively,and followed-up for 1 year to 13 years,the survival rate of the free vascularized tissue flaps was 100%.No complications occurred such as flap crisis,and 10 patients were satisfied with their postoperative shape and function.CONCLUSIONS:Oro-maxillofacial traumatic defects display unique features,and microsurgical techniques play an important role in the reconstruction of shape and function,especially in large defects where local or adjacent flaps can not be used.Accurate assessment of the severity of injury and soft and hard tissue defects,and appropriate selection of free vascularized flaps are the keys to the application of this technique to achieve good results.