游离腓肠内侧动脉穿支皮瓣修复头颈部缺损的初步研究

目的 探讨游离腓肠内侧动脉穿支皮瓣在头颈部缺损修复中的应用.方法 2010年4月至2011年1月16例患者头颈部肿瘤切除后拟用游离腓肠内侧动脉穿支皮瓣修复组织缺损,术前采用超声多普勒血流仪或彩色多普勒超声检测穿支血管,设计皮瓣,术中记录皮瓣大小、穿支血管的数目和血管蒂长度,术后观察游离瓣成活情况,随访记录供区愈合情况及评价术后并发症.结果 最终完成游离腓肠内侧动脉穿支皮瓣修复16例,15例皮瓣术后成活,1例术后因静脉危象手术探查后皮瓣部分存活.供区15例直接缝合,1例植皮.15例供区Ⅰ期愈合,1例因术后供区肌肉坏死行清创手术后愈合.14例术后随访3～ 12个月,所有患者供区除因瘢痕致远端皮肤触觉异常外,远期无明显功能障碍.结论 游离腓肠内侧动脉穿支皮瓣供区并发症轻微,适用头颈部中小型缺损修复.

A preliminary study on free medial sural artery perforator flap for head and neck reconstruction following tumor ablation

Objective To investigate the application of free medial sural artery perforator flap to reconstruct the defect following head and neck tumor ablation.Methods From April 2010 to January 2011,the defects after head and neck tumor resection were reconstructed with free medial sural artery perforator flaps in 16 patients.The clinical data were collected and analyzed,including site and histology of tumor,the skin paddle's size of the flap,the length of pediele,the number of major perforators and donor-site morbidity.Results Medial gastrocnemius territories were evaluated before operation and free medial sural artery perforator flaps were used to reconstruct the defect after tumor ablation in 16 cases.One flap partially survived due to venous thrombosis.All of the other 15 flaps succeeded.The donor site was primarily closed in 15 cases and skin graft was applied in one case.All donor sites except one case healed in first intention.Long-term follow-up showed satisfying receipt-site reconstruction results with good functional and cosmetic outcome in the donor site.There was only minor sensory deficit in the donor site.Conclusions The medial sural artery perforator flap is reliable for reconstruction of the small to medium-sized defect in head and neck region with less donor site morbidity.