摘要
目的探讨累及鼻窦的面部复杂缺损创面的修复方法与临床效果。方法采用回顾性观察性研究方法。2020年1月—2022年5月,中南大学湘雅医院烧伤整形外科收治5例、郴州市第一人民医院烧伤整形科收治4例符合入选标准的累及鼻窦的面部复杂缺损创面患者,其中男6例、女3例,年龄35~69岁,包括4例钛网外露伴鼻窦损伤患者及5例肿瘤累及鼻窦患者。多学科团队合作充分评估损伤情况后,对钛网外露患者行钛网去除、鼻窦清创、鼻窦黏膜去除,对肿瘤患者行肿瘤根治性切除,术后皮肤软组织缺损面积为5.0 cm×2.5 cm~18.0 cm×7.0 cm、鼻窦前壁缺损/缺如面积为3 cm×2 cm~6 cm×4 cm、窦腔深1~4 cm。根据旋股外侧动脉降支的穿支走行情况,移植股前外侧嵌合皮瓣或股前外侧肌皮瓣(皮瓣面积9 cm×4 cm~19 cm×8 cm、肌肉大小5 cm×3 cm×3 cm~11 cm×6 cm×3 cm)修复缺损,将供区创面直接缝合。观察术中移植组织瓣类型、受区血管、血管吻合方式以及术后供受区恢复情况、并发症发生情况,随访受区外观与血运以及溃疡、肿瘤复发情况。结果对6例患者行股前外侧肌皮瓣移植,对3例患者行股前外侧嵌合皮瓣移植。受区血管为面动静脉者3例、为颞浅动静脉者6例,对2例患者采用血流桥接方式桥接组织瓣中血管与颞浅动静脉,7例患者行供受区血管端端吻合。术后组织瓣全部成活,面部缺损创面得到良好修复,无脑脊液漏或鼻窦分泌物漏出,无颅内感染发生,供区创面均愈合良好。术后随访6~35个月,所有患者受区血运良好,外形可;4例钛网外露患者溃疡无复发,5例肿瘤患者无局部肿瘤复发或转移。结论在充分评估面部创面所累及鼻窦范围和缺损性质的基础上,采用股前外侧肌皮瓣或股前外侧嵌合皮瓣移植修复面部伴鼻窦开放的复杂缺损创面,可获得较佳的临床效果。
Objective To explore the repair methods of complex facial defect wounds involving paranasal sinuses and their clinical effectiveness.Methods A retrospective observational study was conducted.From January 2020 to May 2022,5 patients admitted to the Department of Burns and Plastic Surgery of Xiangya Hospital of Central South University and 4 patients admitted to the Department of Burns and Plastic Surgery of Chenzhou First People's Hospital with complex facial defect wounds involving paranasal sinuses met the inclusion criteria,including 6 males and 3 females,aged 35-69 years,including 4 patients with titanium mesh exposure combined with paranasal sinuses injury and 5 patients with tumor involving paranasal sinuses.After an adequate assessment of the damage by a multiple discipline team,titanium mesh removal,paranasal sinus debridement,and paranasal sinus mucosa removal were performed in patients with exposed titanium mesh,and radical tumor resection was performed in patients with tumors,with postoperative skin and soft tissue defects areas of 5.0 cm×2.5 cm to 18.0 cm×7.0 cm,anterior paranasal sinus wall defects/absence areas of 3 cm×2 cm to 6 cm×4 cm,and sinus cavity depths of 1 to 4 cm.Depending on the perforator course of the descending branch of the lateral circumflex femoral artery,the anterolateral femoral chimeric flap or anterolateral femoral myocutaneous flap(with flap area of 9 cm×4 cm to 19 cm×8 cm,muscle size of 5 cm×3 cm×3 cm to 11 cm×6 cm×3 cm)was transplanted to repair the defect,and the donor site wound was sutured directly.The type of tissue flap transplanted,the blood vessel of the recipient area,and the vascular anastomosis way during the operation,the recovery of the donor and recipient areas and the occurrence of complications after operation were observed.The appearance and blood supply of the recipient area and the recurrence of ulcers and tumors were followed up.Results The anterolateral femoral myocutaneous flap transplantation was performed in 6 patients,and the anterolateral femoral chimeric flap transplantation was performed in 3 patients.The blood vessels in recipient areas were facial arteries and veins in 3 cases and superficial temporal arteries and veins in 6 cases.The superficial temporal arteries and veins were bridged with blood vessels in tissue flaps by flow-through way in 2 patients,and end-to-end anastomosis of blood vessels in donor and recipient areas was performed in 7 patients.After operation,all the tissue flaps survived,and the facial defect wounds were well repaired without cerebrospinal fluid leakage or paranasal sinus secretion leakage,no intracranial infection occurred,and the wounds in donor areas were healed well.Follow-up of 6-35 months after operation showed that all the patients had good blood supply in the recipient area,and the shape was acceptable;4 patients with exposed titanium mesh had no recurrence of ulceration,and 5 patients with tumor had no local tumor recurrence or metastasis.Conclusions Based on an adequate assessment of the extent of paranasal sinuses involved in the facial wound and the nature of the defect,good clinical effects can be achieved by using the anterolateral femoral muscle flap or the anterolateral femoral chimeric flap transplantation to repair complex facial defect wounds with open paranasal sinuses.
作者
梁鹏飞
许喜生
张丕红
毕长龙
章华
黄覛韬
何志友
曾纪章
黄云
李佳
崔旭
周思拓
张明华
黄晓元
Liang Pengfei;Xu Xisheng;Zhang Pihong;Bi Changlong;Zhang Hua;Huang Mitao;He Zhiyou;Zeng Jizhang;Huang Yun;Li Jia;Cui Xu;Zhou Situo;Zhang Minghua;Huang Xiaoyuan(Department of Burns and Plastic Surgery,Xiangya Hospital,Central South University,Changsha 410008,China;Department of Burns and Plastic Surgery,Chenzhou First People's Hospital,Chenzhou 423099,China;Department of Neurosurgery,Xiangya Hospital,Central South University,Changsha 410008,China;Department of Otolaryngology-Head and Neck Surgery,Xiangya Hospital,Central South University,Changsha 410008,China)
出处
《中华烧伤与创面修复杂志》
CAS
CSCD
北大核心
2023年第3期221-227,共7页
Chinese Journal of Burns And Wounds
基金
国家自然科学基金面上项目(81974287)。
关键词
创伤和损伤
肿瘤
面部
鼻窦
显微外科手术
外科皮瓣
创面修复
Wounds and injuries
Neoplasms
Face
Paranasal sinuses
Microsurgery
Surgical flaps
Wound repair
