腹壁浅动脉穿支皮瓣修复口腔颌面部软组织缺损3例报道

目的: 评价腹壁浅动脉（superficial inferior epigastric artery,SIEA）穿支皮瓣在口腔颌面部肿瘤术后软组织缺损修复重建中的应用价值。方法 选择临床诊断为舌癌、颊癌、口底癌的患者各1例,术前应用彩色多普勒超声和（或）计算机体层扫描血管造影对双侧下腹部血管条件进行评估,明确腹壁浅动、静脉的起始管径和走行,并完成体表定位。根据病灶部位和缺损大小、形态,设计血管蒂的长度和皮瓣的大小、位置。术中解剖血管蒂,制备皮瓣,转移至受区,完成缺损修复。评价患者的受区重建效果及供区并发症发生情况。术后随访12~14个月。结果 3例患者的腹壁浅动、静脉血管条件良好。根据术区缺损大小,制取的SIEA穿支皮瓣分别为9 cm×6 cm、8 cm×5 cm、10 cm×6 cm,血管蒂长度8~10 cm,血管蒂动脉管径0.7~1.0 mm,静脉管径1.8~2.0 mm,血管分别与受区的甲状腺上动脉、面总静脉吻合。术后皮瓣成活,受区软组织缺损修复效果良好,下腹部供区无并发症。结论 SIEA穿支皮瓣的血管蒂位置比较表浅,可通过影像学检查进行体表定位,降低了皮瓣制备的难度;同时,皮瓣制备过程中不损伤腹直肌鞘及腹部肌肉,术后供区并发症少,且瘢痕隐蔽。SIEA穿支皮瓣可望成为口腔颌面部软组织缺损修复重建较好的临床选择。

Reconstruction of oral and maxillofacial soft tissue defects with superficial inferior epigastric artery flap: report of 3 cases

PURPOSE: To investigate the clinical value of superficial inferior epigastric artery (SIEA) flap in oral and maxillofacial reconstruction. METHODS: Three patients underwent SIEA flap reconstruction. They had malignant tumors in oral cavity with soft tissue defects of the right tongue, left cheek and right mouth floor. All of them received preoperative examinations with color Doppler ultrasound and/or CT angiography to identify the course of SIEA and superficial inferior epigastric vein (SIEV). The planed size and shape of the SIEA flap was transduced to the inguinal region. SIEA and SIEV were dissected proximally and distally until a sufficient pedicle length was obtained. After vascular dissection, the pedicle was clipped. Then, the SIEA flap was transferred to the recipient site and sutured to the soft tissue defect. The reparative effects in recipient sites and complications at the donor sites were evaluated postoperatively. The patients were followed up for 12~14 months. RESULTS: The length of the flap was defined as the largest diameter in the pedicle direction and the width as the largest diameter at right angles to the flap axis. The effective size of the flaps was 9 cm×6 cm, 8cm×5 cm, and 10cm×6cm, respectively. The pedicle length of the SIEA flap was 8-10 cm, the caliber of the SIEA was 0.7-1.0mm. The caliber of the SIEV was 1.8-2.0 mm, the anastomoses between the SIEA and the superficial thyroid artery and the SIEV and one branch of the internal jugular vein were performed under operation microscope. The SIEA flap achieved reperfusion. In all 3 patients, the anastomoses were carried out without complications. Ideal outcome was obtained in the recipient sites. The SIEA flap also had no donor site problems. CONCLUSIONS: SIEA can be tracked by color Doppler and/or CT angiography. Its body surface projection line can also be marked. Therefore, the SIEA flap is easy to harvest. It has a good dimension and tissue quality and can easily be adapted to the soft tissue defect. In comparison with other flaps, it keeps the abdominal wall intact with the scar being hidden. Reconstruction of oral and maxillofacial defect with SIEA flap has several advantages including good functional outcome and low donor site morbidity.