应用游离前锯肌瓣矫治半侧颜面萎缩的初步临床研究

目的探讨应用游离前锯肌瓣矫治半侧颜面萎缩的可行性,并讨论前锯肌瓣的解剖、制作及手术中注意的问题。方法2001年9月~2004年7月,对3例严重半侧颜面萎缩患者采用游离前锯肌瓣移植术,其前锯肌瓣以胸背动、静脉为蒂,与颞浅动、静脉,颌外动、静脉,舌动、静脉等吻合;术中同时解剖胸长神经,并与面神经上颊支吻合。游离肌瓣大小12 cm×8 cm~16 cm×12 cm。结果3例患者术后前锯肌瓣游离移植颜面部凹陷区后色泽血运均良好,肌瓣完全成活,面颊部丰满圆润,无明显突起或不平,颌面部切口愈合好,瘢痕不明显,肩部运动良好,无“翼状肩”。随访1~3年,患者外形恢复满意。结论应用游离前锯肌瓣矫治严重半侧颜面萎缩安全可靠,术后有利于改善患者外形。远期疗效尚待进一步观察。

CLINICAL STUDY ON RECONSTRUCTION OF HEMIFACIAL ATROPHY WITH SERRATUS ANTERIOR FREE-MUSCLE FLAP

OBJECTIVE: To study the method of treating hemifacial atrophy with free serratus muscle flap. METHODS: Three patients diagnosed as having serious hemifacial atroph was treated with free serratus muscle flap. The root of the flap was thoracodorsal artery and thoracodorsal vein, which was anastomosed with superficial temporal artery and vein, facial artery and vein, lingual artery and vein, and so on. During the operation, long thoracic nerve was dissected and anastomosed with facial nerve. The sizes of the flaps were 12 cm x 8 cm - 16 cm x 12 cm. RESULTS: All free-muscle flaps healed well after the transplant. The face and buccal area looked chubby and rounded. There were no obvious protuberance and discontentment on the buccal area. The shoulders of all patients moved well. The facial contour of the patients recovered well during the follow-up period (1-3 years). CONCLUSION: The method has a good result. The long-term effect needs further study.