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

doi:10.19438/j.cjoms.2019.03.017

中国口腔颌面外科杂志 ›› 2019, Vol. 17 ›› Issue (3): 275-279.doi: 10.19438/j.cjoms.2019.03.017

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

麦潋曦, MubarakMashrah, 严凌健, 万全, 林钊宇, 潘朝斌

中山大学孙逸仙纪念医院口腔颌面外科,广东广州 510120

收稿日期:2018-09-10 修回日期:2018-12-10 出版日期:2019-05-20 发布日期:2019-06-21
通讯作者: 潘朝斌,E-mail: docpcb@126.com
作者简介:麦潋曦（1994-）,男,在读硕士研究生,E-mail：maxy-mai@foxmail.com
基金资助:
广州市科技计划项目（20170402130）; 广东省自然科学基金项目（2016A030313196）; 广东省科技发展项目（2017A020215037）

Application of posterior tibial artery flap in the reconstruction of oral and maxillofacial defects: Clinical analysis of 80 consecutive cases

MAI Lian-xi, Mubarak Mashrah, YAN Ling-jian, WAN Quan, LIN Zhao-yu, PAN Chao-bin

Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University. Guangzhou 510120, Guangdong Province, China

Received:2018-09-10 Revised:2018-12-10 Online:2019-05-20 Published:2019-06-21

摘要/Abstract

摘要： 目的: 探讨胫后动脉皮瓣游离移植修复口腔颌面部软组织缺损的临床设计及效果。方法: 2017年11月—2018年8月,应用胫后动脉皮瓣修复中山大学孙逸仙纪念医院收治的80例口腔颌面部肿瘤术后缺损。术前应用计算机体层血管成像（CTA）对双侧下肢血管进行评估,明确胫后动、静脉走向及穿支数量,完成穿支体表定位。术中根据受区部位、缺损大小、形态以设计、制备皮瓣,并转移至受区进行修复。对皮瓣大小、血管蒂长度、血管直径、穿支数量、穿支长度、存活率、外形、供区和受区术后并发症等进行总结分析。结果: 80例患者中,男56例,女24例;年龄24~90（58.17±1.43）岁;皮瓣大小5 cm×6 cm~7 cm×13 cm,皮瓣厚度0.30~1.00(0.53±0.2) cm,血管蒂长度8~14(10.03±1.4) cm;供区动脉直径1.50~3.00(2.36±0.4) mm,供区静脉直径1.50~4.0(2.99±0.6) mm;穿支数量1~5(2.61±0.9)支（集中于小腿内侧中下1/3）,穿支长度0.3~6(1.70±0.7) cm。皮瓣存活率为100%,伤口愈合良好。覆盖于小腿供区缺损处的皮片2例（2.5%）完全坏死,7例（8.7%）部分坏死,但经过换药处理后恢复满意。患者对外形及功能恢复满意。结论: 应用胫后动脉皮瓣修复口腔颌面部缺损是一种较好的修复方式。胫后动脉皮瓣可携带近心端筋膜及皮下脂肪组织,用以丰满舌体形态、充填口底缺损、保护血管蒂。

关键词: 胫后动脉皮瓣, 口腔颌面部缺损, 肿瘤, 修复

Abstract: PURPOSE: To explore the efficacy and design of posterior tibial artery flaps (PTAF) in the reconstruction of oral and maxillofacial defects. METHODS: Between November 2017 and August 2018, 80 patients underwent reconstruction of oral and maxillofacial defects with posterior tibial artery flaps. All of them received preoperative examinations with computed tomography angiography (CTA) to identify the course and perforators of the posterior tibial artery. During surgery, the designed and dissected PTAF was transferred to the recipient site and filled the defects. Data including the thickness and the size of the flap, length and diameter of the artery, number and length of perforators, survival rate of the flaps, complications at both the donor and recipient sites were collected and analyzed. RESULTS: Of 80 patients, 56 were male and 24 were female, ranging in age from 24-90(58.17±1.43) years. The flaps measured from 5 cm×6 cm to 7 cm×13 cm, the thickness of the flap was 0.30-1.00(0.53±0.2) cm, the pedicle length of the PTAF was 8-14(10.03±1.4) cm. The caliber of the posterior tibial artery was 1.50-3.00(2.36±0.4) mm, the caliber of the posterior tibial vein was 1.50-4.0(2.99±0.6) mm. The number of the septocutaneous perforator was 1-5(2.61±0.9) per leg, mostly clustered in the middle and distal thirds of the middle surface of the leg. The length of the perforators was 0.3-6(1.70±0.7)cm. All PTAF survived well. Skin graft was required in all cases for donor site of PTAF. Total loss of the skin graft occurred in 2/80 (2.5%) of the patients. Partial loss of the skin graft occurred in 7/80 (8.7%) of the patients, but all healed by conservative treatment. CONCLUTIONS: It's an ideal choice to reconstruct oral and maxillofacial defect with PTAF. Also, caring the adipofascial extension is a better way to plump the form of the tongue, fill up the defect of the mouth floor and protect the vascular anastomosis from outer irritation.

Key words: Posterior tibial artery perforator flaps, Oral and maxillofacial defects, Tumor, Reconstruction

中图分类号:

R782.2

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.

MAI Lian-xi, Mubarak Mashrah, YAN Ling-jian, WAN Quan, LIN Zhao-yu, PAN Chao-bin. Application of posterior tibial artery flap in the reconstruction of oral and maxillofacial defects: Clinical analysis of 80 consecutive cases[J]. China J Oral Maxillofac Surg, 2019, 17(3): 275-279.

参考文献

[1] 胡永杰, 曲行舟, 郑家伟, 等. 游离组织瓣在口腔颌面-头颈肿瘤缺损修复中的应用:2549例临床分析[J]. 中国口腔颌面外科杂志, 2007, 5(5): 335-339.
[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] 毛驰, 俞光岩, 彭歆, 等. 50例口腔颌面部游离前臂皮瓣移植的临床分析[J]. 现代口腔医学杂志, 2002, 16(2): 138-140.
[4] 罗兆彪, 吕国华, 董忠根, 等. 远端蒂腓动脉和胫后动脉的穿支筋膜蒂皮瓣临床应用的比较[J]. 中华显微外科杂志, 2018,41(1): 22-26.
[5] 万光勇, 张明宾, 刘太生, 等. 小腿内侧皮瓣在口腔颌面部术后缺损修复中的应用[J]. 中国口腔颌面外科杂志, 2006, 4(6): 471-474.
[6] 周剑虹, 许振华, 任常群, 等. 小腿内侧皮瓣在修复舌癌术后缺损中的临床应用[J]. 口腔医学研究, 2014, 30(10): 967-969.
[7] Xu Z, Shang D, Duan W, et al.Free posterior tibial artery perforator flap for floor of mouth reconstruction: a case report[J]. Microsurgery, 2011, 31(8): 659-661.
[8] Chen F, Liu J, Lv D, et al.Reconstruction of the oropharynx with free posterior tibial flap after tonsillar cancer extirpation[J]. J Oral Maxillofac Surg, 2014, 72(10): 2083-2091.
[9] Lee J, Chen P, Cheng L, et al.A comparison between proximal lateral leg flap and radial forearm flap for intraoral reconstruction[J]. Ann Plast Surg, 2013,71(Suppl 1): S43-S47.
[10] Wei FC, Suominen S, Cheng MH, et al.Anterolateral thigh flap for postmastectomy breast reconstruction[J]. Plast Reconstr Surg, 2002, 110(1): 82-88.
[11] Kimura N, Satoh K.Consideration of a thin flap as an entity and clinical applications of the thin anterolateral thigh flap[J]. Plast Reconstr Surg, 1996, 97(5): 985-992.
[12] 何悦, 方早, 金淑芳, 等. 腓肠内侧动脉穿支皮瓣修复舌缺损的疗效评价[J]. 中国口腔颌面外科杂志, 2015, 13(2): 134-139.
[13] Toyserkani NM, Sϕrensen JA.Medial sural artery perforator flap: a challenging free flap[J]. Eur J Plast Surg, 2015, 38(5): 391-396.
[14] Kao HK, Chang KP, Wei FC, et al.Comparison of the medial sural artery perforator flap with the radial forearm flap for head and neck reconstructions[J]. Plast Reconstr Surg, 2009, 124(4): 1125-1132.
[15] 赵文权, 刘建华, 刘超, 等. 腓肠内侧动脉穿支皮瓣修复舌癌术后缺损疗效观察[J]. 中国修复重建外科杂志, 2015, 29(3): 331-334.
[16] Schaverien M, Saint-Cyr M.Perforators of the lower leg: analysis of perforator locations and clinical application for pedicled perforator flaps[J]. Plast Reconstr Surg, 2008, 122(1): 161-170.
[17] 于大志, 方光荣, 汤海萍, 等. 胫后动脉穿支皮瓣不同厚度血供范围的解剖学研究[J]. 中华显微外科杂志, 2015, 38(4): 372-376.
[18] 张大明, 王友元, 梁启祥, 等. 负压封闭引流技术在游离前臂皮瓣修复术后供区植皮中的应用[J]. 中国口腔颌面外科杂志, 2015, 13(4): 370-372.
[19] 王小静, 吴翔, 李英莎, 等. 糖尿病足患者细菌感染特征及其与下肢血管病变程度的关系[J]. 第三军医大学学报, 2016, 38(9): 982-986.

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

Application of posterior tibial artery flap in the reconstruction of oral and maxillofacial defects: Clinical analysis of 80 consecutive 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]	韩林孜, 周建华, 赵谦, 董磊, 陈正岗, 邱建忠, 袁荣涛. 肿瘤相关成纤维细胞对头颈部鳞状细胞癌肿瘤浸润免疫细胞的调控作用及机制探讨[J]. 中国口腔颌面外科杂志, 2023, 21(2): 119-124.
[2]	王悦平, 徐诸凤, 施佳敏, 袁卫军, 侯黎莉. “新冠”疫情下一种新型气管切开导管防护装置在口腔肿瘤患者中的应用[J]. 中国口腔颌面外科杂志, 2023, 21(2): 137-141.
[3]	胡潇丹, 徐豪越, 李晓, 卜令学, 贾暮云, 袁荣涛, 庞宝兴. 超声刀在辅助制备游离腓骨肌皮瓣中的临床应用[J]. 中国口腔颌面外科杂志, 2023, 21(2): 152-157.
[4]	孙守福, 张莹, 赵昊明, 王文超, 魏文佳, 郭克. 数字化导板辅助下左上根折中切牙不翻瓣即刻种植即刻自体冠修复1例报告[J]. 中国口腔颌面外科杂志, 2023, 21(2): 197-202.
[5]	兰嵘, 阮敏, 韩楠男, 王凤. 左下种植修复后发生植体周围鳞状细胞癌1例报告[J]. 中国口腔颌面外科杂志, 2023, 21(2): 203-205.
[6]	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.
[7]	葛良玉, 季莉, 王浩然, 李志萍, 顾倩平, 孟箭. 适形前臂桡侧皮瓣修复面颊部软组织缺损的效果评价[J]. 中国口腔颌面外科杂志, 2023, 21(1): 24-28.
[8]	龚霞, 李佳, 熊屏, 丁昂昂. 头颈部脉管肿瘤的超声诊断[J]. 中国口腔颌面外科杂志, 2022, 20(6): 521-526.
[9]	席庆. 舌根肿瘤,开放手术还是机器人手术?[J]. 中国口腔颌面外科杂志, 2022, 20(6): 527-533.
[10]	张森林, 魏斌, 梁彤欣. 逆行Yu瓣修复上唇全厚缺损：1例报告及文献复习[J]. 中国口腔颌面外科杂志, 2022, 20(6): 618-620.
[11]	徐诸凤, 侯黎莉, 王悦平, 谢瑜婷, 刘浏, 郁玺玺. 基于德尔菲法的口腔颌面头颈肿瘤患者气管切开居家护理方案的构建[J]. 中国口腔颌面外科杂志, 2022, 20(4): 371-377.
[12]	曾丽婷, 吴嘉骏, 范晶娴, 王伟, 杨天页, 王繁麟, 徐兵, 葛奎. 拉出法与插入法经皮内镜下胃造瘘术在口腔颌面部恶性肿瘤患者中的应用效果比较[J]. 中国口腔颌面外科杂志, 2022, 20(4): 401-404.
[13]	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.
[14]	仝春实, 马欣, 范明亮, 王永功, 彭利伟, 骆书文. 8例青少年沙瘤样骨化纤维瘤临床分析[J]. 中国口腔颌面外科杂志, 2022, 20(3): 287-291.
[15]	孙丹丹, 石飒飒, 尹伟娇. 78例氧化锆种植体边缘骨吸收5年随访观察[J]. 中国口腔颌面外科杂志, 2022, 20(2): 168-172.