穿支皮瓣修复口腔颌面-头颈部缺损专家共识

doi:10.19438/j.cjoms.2020.05.001

中国口腔颌面外科杂志 ›› 2020, Vol. 18 ›› Issue (5): 385-389.doi: 10.19438/j.cjoms.2020.05.001

穿支皮瓣修复口腔颌面-头颈部缺损专家共识

何悦¹, 蒋灿华², 侯劲松³, 王慧明⁴, 彭歆⁵, 刘冰⁶, 李劲松⁷, 郑磊⁵, 徐中飞⁸, 吴煜农⁹, 胡镜宙¹, 秦兴军¹, 艾松涛¹⁰, 周辉红¹¹, 李春洁¹², 张世周¹³, 王军¹⁴, 李晓光¹, 刘忠龙¹, 祝奉硕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,上海 200011;
2.中南大学湘雅医院口腔颌面外科,湖南长沙 410008;
3.中山大学光华口腔医学院附属口腔医院口腔颌面外科,广东广州 510055;
4.浙江大学口腔医学院,浙江大学医学院附属第一医院口腔颌面外科,浙江杭州 310006;
5.北京大学口腔医学院口腔颌面外科,北京 100081;
6.武汉大学口腔医院口腔颌面外科,湖北武汉 430070;
7.中山大学孙逸仙纪念医院口腔颌面外科,广东广州 510120;
8.中国医科大学附属口腔医院口腔颌面-头颈外科,辽宁沈阳 110002;
9.南京医科大学附属口腔医院口腔颌面外科,江苏南京 210029;
10.上海交通大学医学院附属第九人民医院影像科,上海 200011;
11.上海交通大学医学院附属第九人民医院超声科,上海 200011;
12.四川大学华西口腔医院头颈肿瘤外科,四川成都 610041;
13.山东第一医科大学附属省立医院口腔颌面外科,山东济南 250021;
14.甘肃省肿瘤医院头颈二科,甘肃兰州 730050

收稿日期:2020-04-30 修回日期:2020-05-06 出版日期:2020-09-20 发布日期:2020-10-28
通讯作者: 何悦,E-mail:william5218@126.com
作者简介:何悦（1973-）,男,教授,主任医师,博士研究生导师
基金资助:
上海交通大学研究型医师项目（20152222）

Expert consensus statement on application of perforator flap in oromaxillofacial head and neck defect reconstruction

HE Yue¹, JIANG Can-hua², HOU Jin-song³, WANG Hui-ming⁴, PENG Xin⁵, LIU Bing⁶, LI Jin-song⁷, ZHENG Lei⁵, XU Zhong-fei⁸, WU Yu-nong⁹, HU Jing-zhou¹, QIN Xing-jun¹, AI Song-tao¹⁰, ZHOU Hui-hong¹¹, LI Chun-jie¹², ZHANG Shi-zhou¹³, WANG Jun¹⁴, LI Xiao-guang¹, LIU Zhong-long¹, ZHU Feng-shuo¹

1. Department of Oromaxillofacial Head and Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine. Shanghai 200011;
2. Department of Oral and Maxillofacial Surgery, Xiangya Hospital Central South University. Changsha 410008, Hunan Province;
3. Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University. Guangzhou 510055, Guangdong Province;
4. Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhejiang University of Medicine, School of Stomatology, Zhejiang University. Hangzhou 310006, Zhejiang Province;
5. Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology. Beijing 100081;
6. Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Wuhan University. Wuhan 430070, Hubei Province;
7. Department of Oral and Maxillofacial Surgery, Sun Yat -sen Memorial Hospital, Sun Yat-sen University. Guangzhou 510120, Guangdong Province;
8. Department of Oromaxillofacial Head and Neck Surgery, School and Hospital of Stomatology, China Medical University. Shenyang 110002, Liaoning Province;
9. Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital of Nanjing Medical University. Nanjing 210029, Jiangsu Province;
10. Radiology Department, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. Shanghai 200011;
11. Ultrasonic Department, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. Shanghai 200011;
12. Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology. Chengdu 610041, Sichuan Province;
13. Department of Oral and Maxillofacial Surgery, Shandong First Medical University. Jinan 250021, Shandong Province;
14. Department of Head and Neck Oncology, Gansu Provincial Cancer Hospital. Lanzhou 730050, Gansu Province, China

Received:2020-04-30 Revised:2020-05-06 Online:2020-09-20 Published:2020-10-28

摘要/Abstract

摘要： 穿支皮瓣由皮肤穿支血管供血,是常用的组织缺损修复形式,但头颈部解剖复杂、缺损形式多样以及穿支血管解剖变异等,阻碍了穿支皮瓣在口腔颌面-头颈部缺损修复中的进一步应用。迄今为止,国内外对于穿支皮瓣修复口腔颌面-头颈部缺损临床应用缺少相关治疗指南,穿支血管的术前评价缺乏统一标准,穿支皮瓣的应用设计缺乏科学的规范,穿支皮瓣修复术后缺少客观的监测和评价体系。为进一步统一和规范穿支皮瓣在口腔颌面-头颈部缺损修复中的应用,提高重建效果,本共识总结全国多家著名医学院校及附属医院口腔颌面外科专家团队的实践经验,供临床医师参考。

关键词: 穿支皮瓣, 口腔颌面-头颈部缺损, 修复重建, 专家共识

Abstract: Perforator flap is supplied by the cutaneous perforator vessels, which is a common modality to reconstruct the defect tissue. However, the complex anatomy, the variety of defects in the head and neck and the perforator vessel variation prevent perforator flap from application further. So far, there is no guideline for the clinical application of perforator flaps to repair oral maxillofacial head and neck defects. Preoperative evaluation of perforator vessels lacks uniform standards and the design of perforator flaps lacks reasonable norms. There is no objective monitoring and evaluation system after perforator flap reconstruction. To further standardize the application of perforator flaps and improve the reconstruction effect in oral maxillofacial head and neck defect, this consensus summarized the practical experience of oral and maxillofacial surgeons for clinical reference.

Key words: Perforator flap, Oromaxillofacial head and neck defect, Reconstruction, Expert consensus

中图分类号:

R782.2

何悦, 蒋灿华, 侯劲松, 王慧明, 彭歆, 刘冰, 李劲松, 郑磊, 徐中飞, 吴煜农, 胡镜宙, 秦兴军, 艾松涛, 周辉红, 李春洁, 张世周, 王军, 李晓光, 刘忠龙, 祝奉硕. 穿支皮瓣修复口腔颌面-头颈部缺损专家共识[J]. 中国口腔颌面外科杂志, 2020, 18(5): 385-389.

HE Yue, JIANG Can-hua, HOU Jin-song, WANG Hui-ming, PENG Xin, LIU Bing, LI Jin-song, ZHENG Lei, XU Zhong-fei, WU Yu-nong, HU Jing-zhou, QIN Xing-jun, AI Song-tao, ZHOU Hui-hong, LI Chun-jie, ZHANG Shi-zhou, WANG Jun, LI Xiao-guang, LIU Zhong-long, ZHU Feng-shuo. Expert consensus statement on application of perforator flap in oromaxillofacial head and neck defect reconstruction[J]. China J Oral Maxillofac Surg, 2020, 18(5): 385-389.

参考文献

[1] 张世民, 唐茂林, 穆广态, 等. 穿支皮瓣及相关术语的专家共识[J].中国临床解剖学杂志, 2010, 28(5): 475-477.
[2] Koshima I, Soeda S.Inferior epigastric artery skin flaps without rectus abdominis muscle[J]. Br J Plast Surg, 1989, 42(6): 645-648.
[3] 何悦. 穿支皮瓣:口腔颌面与头颈部的应用[M]. 上海: 上海交通大学出版社, 2018.
[4] Wong CH, Wei FC.Anterolateral thigh flap[J]. Head Neck, 2010,32(4): 529-540.
[5] Ali RS, Bluebond-Langner R, Rodriguez ED, et al.The versatility of the anterolateral thigh flap[J]. Plast Reconstr Surg, 2009, 124(6 Suppl): e395-e407.
[6] Lin DT, Coppit GL, Burkey BB.Use of the anterolateral thigh flap for reconstruction of the head and neck[J]. Curr Opin Otolaryngol Head Neck Surg, 2004, 12(4): 300-304.
[7] He Y, Jin SF, Zhang CP, et al.Medial sural artery perforator flap aided by preoperative computed tomography angiography mapping for tongue reconstruction[J]. Int J Oral Maxillofac Surg, 43(9): 1064-1068.
[8] Zhao W, Li Z, Wu L, et al.Medial sural artery perforator flap aided by ultrasonic perforator localization for reconstruction after oral carcinoma resection[J]. J Oral Maxillofac Surg, 2016, 74(5): 1063-1071.
[9] He Y, Jin S, Tian Z, et al.Superficial circumflex iliac artery perforator flap's imaging, anatomy and clinical applications in oral maxillofacial reconstruction[J]. J Craniomaxillofac Surg, 2015, 44(3): 242-248.
[10] Ma C, Tian Z, Kalfarentzos E, et al.Superficial circumflex iliac artery perforator flap: a promising candidate for large soft tissue reconstruction of retromolar and lateral buccal defects after oncologic surgery[J]. J Oral Maxillofac Surg,73(8): 1641-1650.
[11] Green R, Rahman KM, Owen S, et al.The superficial circumflex iliac artery perforator flap in intra-oral reconstruction[J]. J Plast Reconstr Aesthet Surg, 2013, 66(12): 1683-1687.
[12] Cappiello J, Piazza C, Taglietti V, et al.Deep inferior epigastric artery perforated rectus abdominis free flap for head and neck reconstruction[J]. Eur Arch Otorhinolaryngol, 2012, 269(4): 1219-1224.
[13] MasiàJ, Sommario M, Cervelli D, et al. Extended deep inferior epigastric artery perforator flap for head and neck reconstruction: a clinical experience with 100 patients[J]. Head Neck, 2011,33(9): 1328-1334.
[14] Huang L, Wang WM, Gao X, et al.Reconstruction of intraoral defects after resection of cancer with two types of submental artery perforator flaps[J]. Br J Oral Maxillofac Surg, 2018, 56(1): 34-38.
[15] Kim JT, Kim SK, Koshima I, et al.An anatomic study and clinical applications of the reversed submental perforator-based island flap[J]. Plast Reconstr Surg, 2002,109(7): 2204-2210.
[16] 中华医学会麻醉学分会. 2014版中国麻醉学指南与专家共识[M].北京:人民卫生出版社,2014.
[17] Golusiński P, Luczewski Ł, 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.
[18] Mijuskovic B, Tremp M, Heimer MM, et al.Color Doppler ultrasound and computed tomographic angiography for perforator mapping in DIEP flap breast reconstruction revisited: A cohort study[J]. J Plast Reconstr Aesthet Surg, 2019, 72(10): 1632-1639.
[19] Ensat F, Babl M, Conz C, et al.The efficacy of color duplex sonography in preoperative assessment of anterolateral thigh flap[J]. Microsurgery, 2012, 32(8): 605-610.
[20] Chen SY, Lin WC, Deng SC, et al.Assessment of the perforators of anterolateral thigh flaps using 64-section multidetector computed tomographic angiography in head and neck cancer reconstruction[J]. Eur J Surg Oncol, 2010, 36(10): 1004-1011.
[21] Rozen WM, Ashton MW, Stella DL, et al.Developments in perforator imaging for the anterolateral thigh flap: CT angiography and CT-guided stereotaxy[J]. Microsurgery, 2008, 28(4): 227-232.
[22] Kagen AC, Hossain R, Dayan E, et al.Modern perforator flap imaging with high-resolution blood pool MR angiography[J]. Radiographics, 2015, 35(3): 901-915.
[23] Rozen WM, Stella DL, Phillips TJ, et al.Magnetic resonance angiography in the preoperative planning of DIEA perforator flaps[J]. Plast Reconstr Surg, 2008,122(6): 222e-223e.
[24] Cai TY, Zhang WB, Yu Y, et al.Scoring system for selective tracheostomy in head and neck surgery with free flap reconstruction[J]. Head Neck, 2020, 42(3): 476-484.
[25] 张志愿. 口腔颌面外科学[M]. 第7版. 北京: 人民卫生出版社, 2012.
[26] Hardwicke JT, Osmani O, Skillman JM.Detection of perforators using smartphone thermal imaging[J]. Plast Reconstr Surg, 2016, 137(1): 39-41.
[27] Brown L, Rieger JM, Harris J, et al.A longitudinal study of functional outcomes after surgical resection and microvascular reconstruction for oral cancer: tongue mobility and swallowing function[J]. J Oral Maxillofac Surg, 2010, 68(11): 2690-2700.
[28] Ni S, Zhu Y, Qu D, et al.Morbidity and functional outcomes following free jejunal flap reconstruction for head and neck cancer[J]. ORL J Otorhinolaryngol Relat Spec, 2017, 79(4): 212-221.
[29] Loewen IJ, Boliek CA, Harris J, et al.Oral sensation and function: a comparison of patients with innervated radial forearm free flap reconstruction to healthy matched controls[J]. Head Neck, 2010, 32(1): 85-95.
[30] 国家标准化管理委员会. GB/T 13504-2008 汉语清晰度诊断押韵测试法[S]. 2008.

相关文章 15

[1]	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.
[2]	郑家伟, 王绪凯, 秦中平, 范新东, 李凯, 杨耀武, 霍然, 刘少华, 赵吉宏, 汪小勇, 周德凯, 刘学键. 口服普萘洛尔治疗婴幼儿血管瘤中国专家共识（2022版）[J]. 中国口腔颌面外科杂志, 2022, 20(4): 313-319.
[3]	刘冰, 何悦, 彭歆, 孙长伏, 韩正学, 吴煜农, 彭利伟, 赵熠, 陶谦, 韩新光, 李劲松, 苏彤, 李波, 张雷, 胡砚平, 陈传俊, 李一, 李铁军, 赵怡芳. 牙源性角化囊肿诊疗中国专家共识[J]. 中国口腔颌面外科杂志, 2022, 20(3): 209-218.
[4]	王育新, 王志勇, 王永功, 王慧明, 王丽珍, 田皞, 叶金海, 付坤, 阮敏, 孙长伏, 孙国文, 刘法昱, 许碧云, 后军, 刘冰, 刘亮, 陈永锋, 陈占伟, 肖灿, 李思毅, 李志勇, 李勇, 李楠, 张陈平, 张东升, 张胜, 张凯, 杨溪, 何巍, 苏彤, 季彤, 林李嵩, 罗瑞华, 赵志立, 胡勤刚, 唐瞻贵, 徐蔚嘉, 黄志权, 黄晓峰, 梁玉洁, 韩正学, 韩伟, 蒋灿华, 喻建军, 蔡志刚, 廖贵清, 廖圣恺, 蔡惠明, 魏建华. 吲哚菁绿荧光成像技术在口腔鳞癌治疗中的应用：中国专家共识[J]. 中国口腔颌面外科杂志, 2022, 20(1): 1-6.
[5]	史伟红, 刘严, 阿曼妮萨罕·加帕尔, 阿依达娜·乌拉尔别克, 贺琦, 凌彬. 3D打印定位导板在辅助制备股前外侧穿支皮瓣中的临床应用[J]. 中国口腔颌面外科杂志, 2022, 20(1): 52-57.
[6]	郭伟, 任国欣, 孙沫逸, 孔蕴毅, 王丽珍, 步荣发, 冉炜, 唐瞻贵, 李龙江, 孟箭, 孙志军, 尚伟, 吕炯, 武和明, 张陈平, 何悦, 马旭辉, 宋浩, 鞠侯雨, 郑家伟, 龚忠诚, 杨凯, 张杰, 吴云腾. 中国人口腔黏膜黑色素瘤临床诊治专家共识[J]. 中国口腔颌面外科杂志, 2021, 19(6): 481-488.
[7]	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.
[8]	马春跃, 朱云, 郭兵, 王良, 沈毅. 头颈部缺损重建术后持续性口底瘘或口咽瘘的救治性治疗[J]. 中国口腔颌面外科杂志, 2021, 19(4): 362-367.
[9]	中华口腔医学会牙及牙槽外科专业委员会. 自体牙移植术规范化操作流程中国专家共识[J]. 中国口腔颌面外科杂志, 2020, 18(5): 390-394.
[10]	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.
[11]	江灿洋, 施斌, 黄建平, 江燕, 朱小峰, 黄立, 林李嵩. 游离血管化复合组织瓣在口腔颌面部严重创伤性缺损畸形整复中的应用：11例临床分析[J]. 中国口腔颌面外科杂志, 2020, 18(2): 155-159.
[12]	唐瞻贵, 步荣发, 郭伟, 孙沫逸, 郑家伟, 彭歆, 张惠, 段小红, 姜虹, 王淼, 张铁军, 杨旭东, 杨凯, 喻建军, 罗志勇, 谢咏秋, 胡延佳, 王柏胜. 口腔医疗中恶性高热临床诊治中国专家共识[J]. 中国口腔颌面外科杂志, 2020, 18(1): 1-9.
[13]	李军, 黄晶, 高炳菊, 邱宇, 林阳, 阮召伟, 叶卓, 林李嵩. 腹壁下动脉穿支皮瓣在全舌癌缺损修复中的应用效果评价[J]. 中国口腔颌面外科杂志, 2019, 17(6): 550-553.
[14]	蒋灿华, 翦新春, 张志愿, 郑家伟, 石冰, 刘彦普, 何悦, 彭歆, 尚政军, 韩新光, 刘蔚东, 莫洋, 郭峰, 程智刚, 陈传俊, 龚忠诚, 金武龙, 张世周, 袁荣涛, 严奉国, 李鹏程, 张胜, 高兴, 陈洁. 口腔颌面外科日间手术中国专家共识[J]. 中国口腔颌面外科杂志, 2019, 17(5): 385-390.
[15]	刘建华, 张志愿, 石冰, 郭传瑸, 孙坚, 王慧明, 孙长伏, 郑谦. 唇缺损局部组织瓣修复重建专家共识[J]. 中国口腔颌面外科杂志, 2019, 17(5): 391-396.

穿支皮瓣修复口腔颌面-头颈部缺损专家共识

Expert consensus statement on application of perforator flap in oromaxillofacial head and neck defect reconstruction

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