面动脉穿支接力皮瓣修复中面部缺损

摘要

目的 探讨面动脉穿支接力皮瓣修复中面部中等面积缺损的临床应用.方法 遵义医科大学附属医院烧伤整形外科2017年10月至2018年3月收治面部肿瘤及外伤患者16例,男性8例,女性8例,年龄41 ～ 74岁,其中外伤4例,鳞癌2例,基底细胞癌10例.肿瘤及外伤面积为0.3 cm ×2.0cm～2.0cm× 4.0cm.肿瘤患者根据肿瘤的性质扩大根治切除肿瘤组织,外伤患者常规清创.根据受伤面积,设计面动脉穿支接力皮瓣.一级接力皮瓣大小、形状与缺损面积相近,且供区瘢痕尽可能平行或隐藏于鼻唇沟、鼻颊沟内.以鼻外侧动脉分支穿支为蒂,完整切取后经暗道无张力转移覆盖受区创面.于一级皮瓣供区同侧设计以鼻旁动脉穿支为蒂的二级接力皮瓣,形状为类三角形,略大于一级皮瓣,蒂部位于皮瓣中间部,推进皮瓣覆盖一级皮瓣供区.术后由患者对手术效果进行自评.结果 16例患者中,所有一、二级接力皮瓣均成活,切口一期愈合.随访3～12个月,平均7.5个月.所有患者术区瘢痕均不明显,无睑外翻、睑球分离及口角歪斜等情况,所有肿瘤患者无复发.一、二级皮瓣的外观、颜色等与正常皮肤相近,皮瓣无臃肿,修复效果较好.末次随访患者自评:非常满意10例,满意6例.结论 应用面动脉穿支接力皮瓣修复中面部中小面积缺损,临床效果较好.%Objective To explore the clinical application of facial artery perforator flap in repairing medium-size midfacial defects.Methods Sixteen patients with facial tumors or trauma were admitted in the Affiliated Hospital of Zunyi Medical University,from October 2017 to March 2018.The patients were 41-74 years of age,including 8 males and 8 females.The tissue defects were caused by basal cell carcinoma(BCC,n=10),trauma (n =4),and squamous cell carcinoma (SqCa,n =2).The size of tumor and trauma ranged from O.3 cm×2 cm to 2 cm×4 cm.Patients with skin tumors undergone extended radical resection,according to the nature of the tumor.Debridement was performed routinely in patients with trauma.Facial artery perforator flap was designed based on the size and shape of defect area.The scar of donor site was as parallel or hidden in the nasolabial groove.The perforator branch of the lateral nasal artery was used as the pivot point,to cover the wound surface without tension.The ipsilateral secondary relay flap pedicled with the perforator of the nasal artery was designed,which was in triangular shape and slightly larger in size than the primary flap.The pedicle was located in the middle of the flap,then the flap was pushed to cover the donor site of primary flap.The postoperative results were evaluated by patients.Results All primary and secondary relay skin flaps survived.The follow-up period of the first stage was 3-12 months,with an average of 7.5 months.There was no obvious scar,no eyelid eversion or angular deviation,and no recurrence of tumor was observed.The primary and secondary flaps have similar appearance and matched color with normal skin.Ten patients were very satisfied with the surgical outcome,and 6 were satisfied,at the latest follow-up.Conclusions The facial artery perforator relay skin flap is an alternative method to repair medium facial defect.