CAJ | 학술논문

目的：??探讨旋髂深动脉穿支嵌合髂骨皮瓣（DCIAPF）在下颌骨复合性缺损重建中的应用价值与优缺点。方法??2014年3—7月应用DCIAPF游离移植一期修复6例下颌骨及软组织复合缺损患者。根据术前定位的旋髂深动脉皮肤穿支设计并逆行切取皮岛，随后于腹股沟区顺行解剖血管蒂并切取髂骨瓣，继续解剖旋髂深血管直至终末段与皮岛相续。完成DCIAPF切取后供区分层严密关闭以预防腹疝。结果??6例患者所制备的髂骨瓣长5.0~11.0?cm，皮岛3.5?cm×5.0?cm~7.0?cm×10.0?cm，供区均一期关闭未行植皮。1例皮岛穿支来自旋髂浅血管需另行吻合，其余5例成功制备为DCIAPF。移植的髂骨皮瓣均成活，仅1例因行皮岛修薄处理出现表皮剥脱和少量边缘坏死，经修剪及换药处理后愈合。术后随访3~6个月，牙槽嵴高度恢复满意，供区均未出现明显并发症。结论??DCIAPF血运丰富可靠，能提供足够的骨量供下颌骨重建并恢复牙槽嵴高度，为后期义齿修复创造有利条件；其皮肤穿支解剖较为恒定，携带皮岛组织量大，摆放灵活，供区隐蔽，是下颌骨复合性缺损修复重建的有效方法。
목적：??탐토선가심동맥천지감합가골피판（DCIAPF）재하합골복합성결손중건중적응용개치여우결점。방법??2014년3—7월응용DCIAPF유리이식일기수복6례하합골급연조직복합결손환자。근거술전정위적선가심동맥피부천지설계병역행절취피도，수후우복고구구순행해부혈관체병절취가골판，계속해부선가심혈관직지종말단여피도상속。완성DCIAPF절취후공구분층엄밀관폐이예방복산。결과??6례환자소제비적가골판장5.0~11.0?cm，피도3.5?cm×5.0?cm~7.0?cm×10.0?cm，공구균일기관폐미행식피。1례피도천지래자선가천혈관수령행문합，기여5례성공제비위DCIAPF。이식적가골피판균성활，부1례인행피도수박처리출현표피박탈화소량변연배사，경수전급환약처리후유합。술후수방3~6개월，아조척고도회복만의，공구균미출현명현병발증。결론??DCIAPF혈운봉부가고，능제공족구적골량공하합골중건병회복아조척고도，위후기의치수복창조유리조건；기피부천지해부교위항정，휴대피도조직량대，파방령활，공구은폐，시하합골복합성결손수복중건적유효방법。
Objective??To?evaluate?the?feasibility?and?outcomes?of?chimeric?deep?circumflex?iliac?artery?perforator?flap?(DCIAPF)?applied?in?the?simultaneous?reconstruction?of?the?oromandibular?defect. Methods??Six?patients?underwent?simul-taneous?oromandibular?reconstruction?using?DCIAPF?following?segmental?mandibulectomy?in?Xiangya?Hospital?from?March?2014?to?July?2014.?The?skin?paddle?was?designed?to?be?centered?on?the?pre-operative?perforator?mapping.?Retrograde?dissection?was?performed?through?the?underlying?abdominal?wall?to?raise?the?skin?paddle.?The?pedicle?was?isolated?from?the?groin,?and?the?iliac?crest?was?cut.?The?deep?iliac?circumflex?vessels?were?dissected?until?the?skin?paddle?was?reached.?Finally,?the?donor?site?was?strictly?sutured?layer?by?layer?to?avoid?ventral?hernia.?Results??The?skin?paddles?ranged?from?3.5?cm×5.0?cm?to?7.0?cm× 10.0?cm.?The?length?of?the?bone?components?was?5.0?cm?to?11.0?cm.?All?donor?sites?closed?primarily?without?skin?grafting.?DCIAPF?was?harvested?successfully?in?five?patients,?except?for?one?patient?whose?perforator?originated?from?the?superficial?iliac?circumflex?vessels.?An?additional?pair?of?anastomoses?was?performed.?All?iliac?flaps?survived.?However,?slight?skin-edge?necrosis?and?exfoliation?caused?by?flap?thinning?occurred?in?one?patient?and?healed?after?pruning?and?dressing?change.?The?heights?of?all?alveolar?ridges?were?significantly?restored,?and?no?serious?donorsite?complication?was?observed?during?the?three?to?six?months’?follow-up.?Conclusion??DCIAPF?is?a?reconstructive?option?for?mandibular?defects?because?of?its?adequate?bone?tissue?and?rich?blood?supply.?Satisfactory?alveolar?ridge?restoration?greatly?facilitates?future?denture?retention.?DCIAPF?also?has?a?great?degree?of?mobility?between?the?skin?paddle?and?the?bone?component?when?applied?in?composite?oromandibular?defect?reconstruction.