CAJ | 학술논문

目的探讨应用股前外侧脂肪筋膜瓣经血管吻合游离移植修复面部凹陷畸形的手术方法及临床效果.方法 1996年10月至2007年1月,根据面部凹陷的范围及深度,应用相应大小和厚度的股前外侧脂肪筋膜瓣游离移植修复32例面部凹陷畸形,其中8例伴有骨骼缺损的患者同期行Medpor骨膜下植入修复骨骼缺损.结果修复32例面部凹陷畸形共应用33块股前外侧脂肪筋膜瓣,单侧应用31例,双侧应用1例.股前外侧脂肪筋膜瓣的大小为12 cm×8 cm～20 cm×11 cm(平均16.5 cm×10.5 cm).30块股前外侧脂肪筋膜瓣完全存活,另3块于术后半年内出现了边缘的吸收.32例中有23例经一期修复即获得满意效果,其余9例于术后半年行二期修整,其中6例因面部臃肿行脂肪抽吸修薄术矫正,另3例因周边吸收行自体脂肪移植术修复.术后随访6个月至2年半,所有患者面部凹陷畸形均得到显著改善,双侧面部接近对称.供区切口一期愈合,瘢痕隐蔽,未出现功能障碍.结论股前外侧脂肪筋膜瓣町利用的面积大,可修剪成合适厚度用于三维重建,解剖较恒定、切取安全等,必要时可辅以骨骼支架的重建,能使面部凹陷得到较满意的修复.
목적 탐토응용고전외측지방근막판경혈관문합유리이식수복면부요함기형적수술방법급림상효과.방법 1996년10월지2007년1월,근거면부요함적범위급심도,응용상응대소화후도적고전외측지방근막판유리이식수복32례면부요함기형,기중8례반유골격결손적환자동기행Medpor골막하식입수복골격결손.결과 수복32례면부요함기형공응용33괴고전외측지방근막판,단측응용31례,쌍측응용1례.고전외측지방근막판적대소위12 cm×8 cm～20 cm×11 cm(평균16.5 cm×10.5 cm).30괴고전외측지방근막판완전존활,령3괴우술후반년내출현료변연적흡수.32례중유23례경일기수복즉획득만의효과,기여9례우술후반년행이기수정,기중6례인면부옹종행지방추흡수박술교정,령3례인주변흡수행자체지방이식술수복.술후수방6개월지2년반,소유환자면부요함기형균득도현저개선,쌍측면부접근대칭.공구절구일기유합,반흔은폐,미출현공능장애.결론 고전외측지방근막판정이용적면적대,가수전성합괄후도용우삼유중건,해부교항정、절취안전등,필요시가보이골격지가적중건,능사면부요함득도교만의적수복.
Objective To investigate the operative technique and therapeutic effect of free anterolateral thigh adipofascial flap in the correction of facial depression. Methods From Oct. 1996 to Jan. 2007, 32 patients with facial depression deformities were treated with free anterolateral thigh adipofascial flaps. The bone defects in 8 cases were corrected with Medpor implants at the same stage. Results 33 free anterolateral thigh adipofascial flaps were used in 32 patients. 2 flaps were used bilaterally in one patient. The size of the flaps ranged from 12 cm × 8 cm to 20 cm × 11 cm(average, 16. 5 cm × 10. 5 cm). 30 flaps survived completely. Flap edge resorption happened in 3 flaps within half a year postoperatively. Satisfactory results were achieved in 23 patients after one-stage treatment. Another 9 patients underwent secondary operation 6 months postoperatively. Among them, 6 patients underwent flap liposuction because of fatty appearance, 3 patients underwent fat transplantation because of flap edge resorption. The patients were followed up for 6 months to 2. 5 years. All the deformities were improved greatly, and the faces were almost symmetrical. The wounds at the dornor sites were primarily healed with no functional morbidity. Conclusions Free anterolateral thigh adipofascial flap is a large size flap. The flap thickness can be adjusted for three-dimensional reconstruction. The vascular anatomy is relatively stable. The bone defects can also be corrected at the same stage.