旋髂深动脉穿支嵌合髂骨皮瓣修复下颌骨复合性缺损

目的 探讨旋髂深动脉穿支嵌合髂骨皮瓣（DCIAPF）在下颌骨复合性缺损重建中的应用价值与优缺点。方法 2014年3-7月应用DCIAPF游离移植一期修复6例下颌骨及软组织复合缺损患者。根据术前定位的旋髂深动脉皮肤穿支设计并逆行切取皮岛，随后于腹股沟区顺行解剖血管蒂并切取髂骨瓣，继续解剖旋髂深血管直至终末段与皮岛相续。完成DCIAPF切取后供区分层严密关闭以预防腹疝。结果 6例患者所制备的髂骨瓣长5.0~11.0 cm，皮岛3.5 cm×5.0 cm~7.0 cm×10.0 cm，供区均一期关闭未行植皮。1例皮岛穿支来自旋髂浅血管需另行吻合，其余5例成功制备为DCIAPF。移植的髂骨皮瓣均成活，仅1例因行皮岛修薄处理出现表皮剥脱和少量边缘坏死，经修剪及换药处理后愈合。术后随访3~6个月，牙槽嵴高度恢复满意，供区均未出现明显并发症。结论 DCIAPF血运丰富可靠，能提供足够的骨量供下颌骨重建并恢复牙槽嵴高度，为后期义齿修复创造有利条件；其皮肤穿支解剖较为恒定，携带皮岛组织量大，摆放灵活，供区隐蔽，是下颌骨复合性缺损修复重建的有效方法。

Chimeric deep circumflex iliac artery perforator flap for the simultaneous reconstruction of the composite oromandi-bular defect

Objective To evaluate the feasibility and outcomes of chimeric deep circumflex iliac artery perforator flap (DCIAPF) applied in the simultaneous reconstruction of the oromandibular defect. Methods Six patients underwent simultaneous oromandibular reconstruction using DCIAPF following segmental mandibulectomy in Xiangya Hospital from March 2014 to July 2014. The skin paddle was designed to be centered on the pre-operative perforator mapping. Retrograde dissection was performed through the underlying abdominal wall to raise the skin paddle. The pedicle was isolated from the groin, and the iliac crest was cut. The deep iliac circumflex vessels were dissected until the skin paddle was reached. Finally, the donor site was strictly sutured layer by layer to avoid ventral hernia. Results The skin paddles ranged from 3.5 cm×5.0 cm to 7.0 cm×10.0 cm. The length of the bone components was 5.0 cm to 11.0 cm. All donor sites closed primarily without skin grafting. DCIAPF was harvested successfully in five patients, except for one patient whose perforator originated from the superficial iliac circumflex vessels. An additional pair of anastomoses was performed. All iliac flaps survived. However, slight skinedge necrosis and exfoliation caused by flap thinning occurred in one patient and healed after pruning and dressing change. The heights of all alveolar ridges were significantly restored, and no serious donorsite complication was observed during the three to six months’ follow-up. Conclusion DCIAPF is a reconstructive option for mandibular defects because of its adequate bone tissue and rich blood supply. Satisfactory alveolar ridge restoration greatly facilitates future denture retention. DCIAPF also has a great degree of mobility between the skin paddle and the bone component when applied in composite oromandibular defect reconstruction.