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

doi:10.19438/j.cjoms.2018.01.017

中国口腔颌面外科杂志 ›› 2018, Vol. 16 ›› Issue (1): 78-83.doi: 10.19438/j.cjoms.2018.01.017

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

王宏伟¹, 郭兵¹, 马春跃¹, 李晓光¹, 尹建新², 周辉红², 艾松涛³, 孙坚¹, 张陈平¹, 秦兴军¹

1.上海交通大学医学院附属第九人民医院·口腔医学院口腔颌面-头颈肿瘤科,[关键词] 腹壁浅动脉穿支皮瓣; 口腔颌面部; 软组织缺损

收稿日期:2017-07-27 修回日期:2017-09-27 出版日期:2018-01-20 发布日期:2018-02-11
通讯作者: 秦兴军, E-mail: qinxj1989@sina.com
作者简介:王宏伟（1988-）,女,医师,E-mail: xnngo-go@163.com
基金资助:
上海市奉贤区科学技术委员会科学技术发展基金（20161003）

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

WANG Hong-wei¹, GUO Bing¹, MA Chun-yue¹, LI Xiao-guang¹, YIN Jian-xin², ZHOU Hui-hong², AI Song-tao³, SUN Jian¹, ZHANG Chen-ping¹, QIN Xing-jun¹

1.Department of Oromaxillofacial Head and Neck Oncology, College of Stomatology, Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology; National Clinical Research Center of Stomatology. Shanghai 200011;
2. Department of Ultrasonic Diagnosis, 3.Department of Radiology, Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine. Shanghai 200011,China

Received:2017-07-27 Revised:2017-09-27 Online:2018-01-20 Published:2018-02-11

摘要/Abstract

摘要： 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。

关键词: 腹壁浅动脉穿支皮瓣, 口腔颌面部, 软组织缺损

Abstract: 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.

Key words: Superficial inferior epigastric artery flap, SIEA, Oral and Maxillofacial region, Soft tissue defects

中图分类号:

R739.8

王宏伟, 郭兵, 马春跃, 李晓光, 尹建新, 周辉红, 艾松涛, 孙坚, 张陈平, 秦兴军. 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[J]. 中国口腔颌面外科杂志, 2018, 16(1): 78-83.

WANG Hong-wei, GUO Bing, MA Chun-yue, LI Xiao-guang, YIN Jian-xin, ZHOU Hui-hong, AI Song-tao, SUN Jian, ZHANG Chen-ping, QIN Xing-jun. Reconstruction of oral and maxillofacial soft tissue defects with superficial inferior epigastric artery flap: report of 3 cases[J]. China J Oral Maxillofac Surg, 2018, 16(1): 78-83.

参考文献

[1] 徐立群, 张陈平, 张志愿, 等. 血管化游离组织瓣在口腔颌面-头颈部缺损修复中的应用(4640例临床分析)[J]. 实用肿瘤杂志, 2015, 30(1): 18-21.
[2] 张陈平, 张志愿, 邱蔚六, 等. 口腔颌面部缺损的修复重建--1973例临床分析[J]. 中国修复重建外科杂志, 2005, 19(10): 773-776.
[3] Futran ND, Gal TJ, Farwell DG.Radial forearm free flap[J]. Oral Maxillofac Surg Clin North Am, 2003, 15(4): 577-591.
[4] Liu WW, Li H, Guo ZM, et al.Reconstruction of soft-tissue defects of the head and neck: radial forearm flap or anterolateral thigh flap?[J]. Eur Arch Otorhinolaryngol, 2011, 268(12): 1809-1812.
[5] 孙国文, 卢明星, 吴蔚媚, 等. 游离股前外侧皮瓣修复口腔软组织缺损[J]. 中华整形外科杂志, 2011, 27(5): 323-326.
[6] Ensat F, Schubert H, Hladik M, et al. The anterolateral thigh flap: its versatility in oncological soft tissue reconstruction of the head and neck region [J]. Chirurg, 2011, 82(9): 820, 822-827.
[7] Xu Z, Zhao XP, Yan TL, et al.A 10-year retrospective study of free anterolateral thigh flap application in 872 head and neck tumour cases[J]. Int J Oral Maxillofac Surg, 2015, 44(9): 1088-1094.
[8] Collins J, Ayeni O, Thoma A.A systematic review of anterolateral thigh flap donor site morbidity[J]. Can J Plast Surg, 2012, 20(1): 17-23.
[9] Townley WA, Royston EC, Karmiris N, et al.Critical assessment of the anterolateral thigh flap donor site[J]. J Plast Reconstr Aesthet Surg, 2011, 64(12): 1621-1626.
[10] Wu LC, Bajaj A, Chang DW, et al.Comparison of donor-site morbidity of SIEA, DIEP, and muscle-sparing TRAM flaps for breast reconstruction[J]. Plast Reconstr Surg, 2008, 122(3):702-709.
[11] 王晓敏, 马士崟, 张凯. 腹壁浅动脉皮瓣的应用[J]. 国际耳鼻咽喉头颈外科杂志, 2010, 34(5): 290-292.
[12] Arnez ZM, Khan U, Pogorele D, et al.Rational selection of flaps from the abdomen in breast reconstruction to reduce donor site morbidity[J]. Br J Plast Surg, 1999, 52(5): 351-354.
[13] Antia NH, Buch VI.Transfer of abdominal dermo-fat graft by direct Anastomoses of blood vessels[J]. Br J Plast Surg, 1971, 24(1): 15-19.
[14] Allen R.The superficial inferior epigastric artery free flap: an anatomic and clinical study for the use in reconstruction of the breast[C]. Kiawah, SC: proceedings of the 33rd Annual Meeting of the Southeastern Society of Plastic and Reconstructive Surgeons, 1990.
[15] Arnez ZM, Khan U, Pogorelec D, et al.Breast reconstruction using the free superficial inferior epigastric artery (SIEA) flap[J]. Br J Plast Surg, 1999, 52(4): 276-279.
[16] Rizzuto RP, Allen RJ.Reconstruction of a partial mastectomy defect with the superficial inferior epigastric artery (SIEA) flap[J]. J Reconstr Microsurg, 2004, 20(6): 441-445.
[17] Zenn MR.Insetting of the superficial inferior epigastric artery flap in breast reconstruction[J]. Plast Reconstr Surg, 2006, 117(5): 1407-1411.
[18] Wolfram D, Schoeller T, Hussl H, et al.The superficial inferior epigastric artery (SIEA) flap: indications for breast reconstruction[J]. Ann Plast Surg, 2006, 57(6): 593-596.
[19] Spiegel AJ, Khan FN.An Intraoperative algorithm for use of the SIEA flap for breast reconstruction[J]. Plast Reconstr Surg, 2007, 120(6): 1450-1459.
[20] Park JE, Shenaq DS, Silva AK, et al.Breast reconstruction with SIEA flaps: a single institution experience with 145 free flaps[J]. Plast Reconstr Surg, 2016, 137(6): 1682-1689.
[21] Boeckx WD, de Coninck A, Vanderlinden E. Ten free flap transfers: use of intra-arterial dye injection to outline a flap exactly[J]. Plast Reconstr Surg, 1976, 57(6): 716-721.
[22] Hester TR Jr, Nahai F, Beegle PE, et al.Blood supply of the abdomen revisited, with emphasis on the superficial inferior epigastric artery[J]. Plast Reconstr Surg, 1984, 74(5): 657-670.
[23] Stern HS, Nahai F.The versatile superficial inferior epigastric artery free flap[J]. Br J Plast Surg, 1992, 45(4): 270-274.
[24] Koshima I.Short pedicle superficial inferior epigastric artery adiposal flap: new anatomical findings and the use of this flap for reconstruction of facial contour[J]. Plast Reconstr Surg, 2005, 116(4): 1091-1097.
[25] Woodworth BA, Gillespie MB, Day T, et al.Muscle-sparing abdominal free flaps in head and neck reconstruction[J]. Head Neck, 2006, 29(8): 802-807.
[26] Hu YJ, Hardianto A, Li SY, et al.Reconstruction of a palatomaxillary defect with vascularized iliac bone combined with a superficial inferior epigastric artery flap and zygomatic implants as anchorage[J]. Int J Oral Maxillofac Surg, 2007, 36(9): 854-857.
[27] Nasir S, Aydin MA, Altuntas S, et al.Soft tissue augmentation for restoration of facial contour deformities using the free SCIA/SIEA flap[J]. Microsurgery, 2008, 28(5): 333-338.
[28] Bianchi B, Ferri A, Ferrari S, et al.Superficial inferior epigastric artery adiposal flap for facial contour reconstruction: report of two cases[J]. J Craniomaxillofac Surg, 2009, 37(5): 249-252.
[29] Nasr S, Aydn MA.Versatility of free SCIA/SIEA flaps in head and neck defects[J]. Ann Plast Surg, 2010, 65(1): 32-37.
[30] Gaggl AJ, Bürger H, Chiari FM.A combined superficial inferior epigastric artery flap and vascularized iliac crest flap in the reconstruction of extended composite defects of the posterior mandible and adjacent soft tissue: first clinical result[J]. Int J Oral Maxillofac Surg, 2011, 40(2): 162-168.
[31] Iida T, Yoshimatsu H, Tashiro K, et al.Reconstruction of a full-thickness, complex nasal defect that includes the nasal septum using a free, thin superficial inferior epigastric artery flap[J]. Microsurgery, 2016, 36(1): 66-69.
[32] Battisti A, Cassoni AC, Bartoli D, et al. Microsurgical SCIA/SIEA flap for facial contour correction in patient with hemifacial microsomia[J]. Ann Ital Chir, 2017, 88. pii: S0003469X17026641.
[33] Lu M, Sun G, Hu Q, et al.Functional assessment: free thin anterolateral thigh flap versus free radial forearm reconstruction for hemiglossectomy defects[J]. Med Oral Patol Oral Cir Bucal, 2015, 20(6): e757-762.
[34] Gong ZJ, Wang K, Tan HY, et al.Application of thinned anterolateral thigh flap for the reconstruction of head and neck defects[J]. J Oral Maxillofac Surg, 2015, 73(7): 1410-1419.
[35] 孙国文, 卢明星, 吴蔚媚, 等. 薄型股前外侧皮瓣修复口腔软组织缺损[J]. 中华整形外科杂志, 2013, 29(5): 321-324.
[36] Liu WW, Guo ZM.Reconstruction of wide-apart double defect using a branch-based chimeric anterolateral thigh flap[J]. Plast Reconstr Surg Glob Open, 2014, 2(1): e96.
[37] Sun G, Lu M, Hu Q, et al.Reconstruction of extensive through-and-through cheek defects with free anterolateral thigh flap[J]. J Craniofac Surg, 2014, 25(1):e31-38.
[38] Lundgren TK, Wei FC.Oversized design of the anterolateral thigh flap for head and neck reconstruction[J]. J Craniofac Surg, 2013, 24(1): 134-135.
[39] Kekatpure VD, Trivedi NP, Shetkar G, et al.Single perforator based anterolateral thigh flap for reconstruction of large composite defects of oral cavity[J]. Oral Oncol, 2011, 47(6):517-521.
[40] Nasir S, Aydin MA.Wide combined thin free SCIA/SIEA flap[J]. Ann Plast Surg, 2008, 61(6): 627-631.
[41] 吴东方, 庄跃宏, 王建红, 等. 腹壁下动脉穿支皮瓣及腹壁浅动脉皮瓣的血供解剖研究[J]. 中国临床解剖学杂志, 2011, 29(6): 619-623,628.
[42] 王晓敏, 张凯, 马士崟, 等. 腹壁浅动脉皮瓣的应用解剖研究[J]. 中国修复重建外科杂志, 2010, 24(11): 1357-1360.
[43] Taylor GI, Daniel RK.The anatomy of several free flap donor sites[J]. Plast Reconstr Surg, 1975, 56(3): 243-253.
[44] Rozen WM, Chubb D, Grinsell D, et al.The variability of the superficial Inferior epigastric artery (SIEA) and its angiosome: A clinical anatomical study[J]. Microsurgery, 2010, 30(5): 386-391.
[45] Golusiński P, Luczewski L, Pazdrowski J, et al.The role of colour duplex sonography in preoperative perforator mapping of the anterolateral thigh flap[J]. Eur Arch Otorhinolaryngol, 2014, 271(5): 1241-1247.
[46] Jin S, He Y, Tian Z, et al.Superficial circumflex iliac artery perforator flap aided by color Doppler sonography mapping for like-with-like buccal reconstruction[J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2015, 119(2): 170-176.
[47] Piorkowski JR, DeRosier LC, Nickerson P, et al. Preoperative computed tomography angiogram to predict patients with favorable anatomy for superficial inferior epigastric artery flap breast reconstruction[J]. Ann Plast Surg, 2011, 66(5): 534-536.
[48] Fansa H, Schirmer S, Frerichs O, et al.Significance of abdominal wall CT-angiography in planning DIEA perforator flaps, TRAM flaps and SIEA flaps[J]. Handchir Mikrochir Plast Chir, 2011, 43(2): 81-87.
[49] Henry FP, Butler DP, Wood SH, et al.Predicting and planning for SIEA flap utilisation in breast reconstruction: An algorithm combining pre-operative computed tomography analysis and intra-operative angiosome assessment[J]. J Plast Reconstr Aesthet Surg, 2017, 70(6): 795-800.
[50] Coroneos CJ, Heller AM, Voineskos SH, et al.SIEA versus DIEP arterial complications: a cohort study[J]. Plast Reconstr Surg, 2015, 135(5): 802e-807e.
[51] Jiang C, Lin P, Fu X, et al.Three-dimensional contrast-enhanced magnetic resonance angiography for anterolateral thigh flap outlining: A retrospective case series of 68 patients[J]. Exp Ther Med, 2016, 12(2):1067-1074.

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

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

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	柳江龙, 贾芳, 王晓荣, 热伊莱·阿不都克热木, 吾尔古丽·阿力甫, 买买提吐逊·吐尔地. 超声造影对口腔颌面部鳞癌颈部转移性淋巴结的诊断价值评价[J]. 中国口腔颌面外科杂志, 2023, 21(2): 168-174.
[2]	陈伟良. 延长垂直下斜方肌岛状肌皮瓣修复重建大型头颈部缺损[J]. 中国口腔颌面外科杂志, 2023, 21(1): 1-10.
[3]	陈霖, 陈寅瑜, 丁紫雪, 孟箭. 以吞咽困难为首发症状的AL型舌淀粉样变合并多发性骨髓瘤1例报告[J]. 中国口腔颌面外科杂志, 2023, 21(1): 97-101.
[4]	刘迪, 张思敏, 阿迪力江·赛买提, 祖丽胡玛·卡迪, 木合森·牙生江, 尼加提·努尔穆罕默德, 买买提吐逊·吐尔地. 血栓弹力图检测在70例口腔颌面部缺损游离皮瓣修复围术期中的效果评价[J]. 中国口腔颌面外科杂志, 2022, 20(3): 244-250.
[5]	庄乾伟, 李芳芳, 孟箭, 顾倩平, 李志萍. 射频消融联合经皮造影DSA引导下聚多卡醇泡沫硬化剂灌注治疗口腔颌面部静脉畸形38例疗效评价[J]. 中国口腔颌面外科杂志, 2022, 20(2): 135-140.
[6]	陈传俊, 陈伟良, 孙长伏, 何悦, 蒋灿华, 彭歆, 尚政军, 韩正学, 李劲松, 侯劲松, 林李嵩, 韩新光, 魏建华, 王志勇, 吴煜农, 郑家伟, 李龙江, 王慧明, 李祖兵, 郭传瑸, 杨驰, 石冰, 张志愿. 颏下岛状瓣修复口腔颌面部缺损专家共识[J]. 中国口腔颌面外科杂志, 2021, 19(5): 385-391.
[7]	王祎, 陈传俊, 项先旺. 拱顶石皮瓣在颌面部软组织缺损修复中的应用：8例报道[J]. 中国口腔颌面外科杂志, 2021, 19(5): 460-463.
[8]	吴海威, 于淼, 郑家伟. 口腔颌面部静脉畸形诊治：经验与进展[J]. 中国口腔颌面外科杂志, 2021, 19(2): 186-192.
[9]	刘英, 李晨曦, 王冰, 龚忠诚. 热灌注化疗对口腔颌面部恶性肿瘤患者NO及T淋巴细胞的影响[J]. 中国口腔颌面外科杂志, 2020, 18(6): 521-525.
[10]	徐菲菲, 黄林剑, 褚涵文, 徐昕. D二聚体和纤维蛋白原在口腔颌面部间隙感染中的表达及意义[J]. 中国口腔颌面外科杂志, 2020, 18(5): 417-420.
[11]	鞠侯雨, 郑家伟, 孙沫逸, 唐瞻贵, 杨道科, 冉炜, 步荣发, 尚伟, 孟箭, 武和明, 席庆, 杨凯, 王军, 邹建明, 吴云腾, 任国欣, 郭伟. 口腔颌面头颈部鳞癌超声热化疗中国专家共识[J]. 中国口腔颌面外科杂志, 2020, 18(3): 193-198.
[12]	朱昊臻, 孙宇. 盐酸纳布啡超前镇痛对老年口腔颌面部肿瘤手术患者的影响[J]. 中国口腔颌面外科杂志, 2019, 17(4): 316-318.
[13]	赵鹏程, 刘锦星, 纪均. 盐酸戊乙奎醚对接受口腔颌面部手术的老年患者认知功能的影响[J]. 中国口腔颌面外科杂志, 2019, 17(3): 261-264.
[14]	麦潋曦, MubarakMashrah, 严凌健, 万全, 林钊宇, 潘朝斌. 游离胫后动脉皮瓣修复80例口腔颌面部软组织缺损效果评价[J]. 中国口腔颌面外科杂志, 2019, 17(3): 275-279.
[15]	史晓煜, 马慧颖, 张爱华, 武志强. 5762例非住院颌面部外伤患者回顾分析[J]. 中国口腔颌面外科杂志, 2019, 17(3): 285-288.