CAJ | 학술논문

目的探讨游离股前外侧单叶皮瓣制备的外科技术及方法 .方法回顾分析中南大学湘雅第二医院口腔颌面外科244例口腔颌面部恶性肿瘤患者采用245块游离股前外侧单叶肌皮瓣修复术后缺损.皮瓣制备方法 :在髂前上棘至髌骨外上缘的髂-髌连线内侧3 cm处,根据所需皮瓣的厚度在上、中、下不同区域设计切口.选取管径较粗、搏动有力的穿支血管制备皮瓣,携带肌肉组织充填死腔.制备皮瓣面积较大时,尽量带多个穿支血管.皮瓣面积(4 cm×4 cm)～(10 cm×25 cm).对18块皮下脂肪较厚的皮瓣削薄处理.结果 245块肌皮瓣,3块坏死,成功率98.8%.无一块因未找到合适的穿支血管而放弃.8块行皮下脂肪修剪的皮瓣术后出现水疱,但皮瓣血供良好,均成活.5块因取瓣面积较大供区创面行植皮术,所植皮片全部来源于切口的上份;其余供区均直接拉拢缝合.术后244例患者对外形及功能恢复均满意.结论该制备肌皮瓣方法有利于寻找穿支血管;切取皮瓣宽度＜8 cm,创面可直接拉拢缝合,≥8 cm时需要植皮,可选择切口上部为供皮区.
목적 탐토유리고전외측단협피판제비적외과기술급방법 .방법 회고분석중남대학상아제이의원구강합면외과244례구강합면부악성종류환자채용245괴유리고전외측단협기피판수복술후결손.피판제비방법 :재가전상극지빈골외상연적가-빈련선내측3 cm처,근거소수피판적후도재상、중、하불동구역설계절구.선취관경교조、박동유력적천지혈관제비피판,휴대기육조직충전사강.제비피판면적교대시,진량대다개천지혈관.피판면적(4 cm×4 cm)～(10 cm×25 cm).대18괴피하지방교후적피판삭박처리.결과 245괴기피판,3괴배사,성공솔98.8%.무일괴인미조도합괄적천지혈관이방기.8괴행피하지방수전적피판술후출현수포,단피판혈공량호,균성활.5괴인취판면적교대공구창면행식피술,소식피편전부래원우절구적상빈;기여공구균직접랍롱봉합.술후244례환자대외형급공능회복균만의.결론 해제비기피판방법 유리우심조천지혈관;절취피판관도＜8 cm,창면가직접랍롱봉합,≥8 cm시수요식피,가선택절구상부위공피구.
Objective To investigate the surgical techniques and methods of anterolateral thigh (myocutaneous) flap. Methods Two hundred and forty-five consecutive free anterolateral thigh (myocutaneous) flaps for reconstruction of the defects of oral and maxillofacial region following the malignant tumors resection from January 2007 to August 2009 were reviewed. The incision was designed in the upper,middle or lower part 3 cm medial of the iliac-patella line according to the thickness of flaps needed. The perforators with suitable vessel diameter and strong pulse were chosen to make flaps with muscular tissue to fill dead space. More than one perforators were taken when large flaps were harvested. The size of the flaps ranged from 4 cm × 4 cm to 10 cm × 25 cm. Eighteen fat flaps were made thinned. Results Of the 245 flaps harvested, 3 complete necrosis occured, and the survival rate was 98. 8%. Blisters occurred in 8 thinned flaps, but they all survived. All the wounds were closed directly except 5 cases, which needed skin graft because of too large defects of skin. All the skin graft came from the upper part of the wound of donor site. The shape and function were satisfactory after the reconstruction. Conclusions When anterolateral thigh(myocutaneous) flaps are harvested, the incision should be designed 3 cm medial of the iliac-patella line according to the thickness of flaps needed. It is helpful to find the perforators. All of the lower, middle and upper parts of anterolateral thigh region have cutaneous perforators. The skin defects within 8 cm can be closed directly, while the skin defects more than 8 cm often need skin grafting. The skin grafts can be taken from the upper part of donor site wounds.