利用残余耳垂修复累及耳廓的外耳道鳞状细胞癌术区缺损

目的探讨累及耳廓的外耳道癌术区较大皮肤缺损的修复方法。方法分离残余耳垂前后皮肤使之成一扇形皮瓣,向前覆盖耳廓及颞部手术缺损区。结果残余耳垂扇形皮瓣成活良好,外耳道通畅,听力良好,手术创面修复满意,11例患者随访1年均无复发和转移。结论应用残余耳垂皮肤组织形成扇形皮瓣,修复累及耳廓的外耳道癌术区较大皮肤缺损效果好,具有临床推广价值。     

外鼻肿瘤切除术后采用鼻唇沟滑行肌蒂皮瓣修复分析

目的探究鼻唇沟滑行肌蒂皮瓣修复外鼻肿瘤切除后缺损的效果。方法对1例外鼻肿瘤患者进行手术切除,致外鼻部分组织缺损,术中采用鼻唇沟滑行肌蒂皮瓣覆盖手术创面,对位缝合,进行修复,术毕轻度加压包扎,局部放置引流管,防止留下死腔。结果术后2周伤口基本愈合,皮瓣生长良好,鼻面区外观形态无明显损伤。结论鼻唇沟滑行肌蒂皮瓣修复外鼻部分组织缺损,方法实用、简便,且术后鼻外型满意,是一种有效的修复方法,可改善术后的美容效果并提高患者的生存质量。     

前臂桡侧游离皮瓣修复口腔颌面部软组织缺损的临床分析

目的总结前臂桡侧游离皮瓣修复口腔颌面部软组织缺损的经验。方法对14例前臂桡侧游离皮瓣修复口腔颌面部软组织缺损的病例进行回顾性分析,总结临床经验与教训。结果 14例前臂桡侧皮瓣移植术后全部成活,供区创面一期愈合,修复后口腔功能恢复良好,外形基本满意。结论前臂桡侧游离皮瓣解剖结构恒定、制备方便、厚薄适中,是一种理想的口腔颌面部软组织缺损修复皮瓣。     

耳后乳突皮瓣二期修复外伤后耳轮部分缺损

目的 探索外伤后耳轮部分缺损的修复方法.方法 对21例外伤后耳轮部分缺损的患者应用耳后乳突皮瓣进行二期修复.Ⅰ期手术前评估耳郭前面及后面组织缺损面积,根据缺损大小设计、形成蒂在后的耳后乳突区皮瓣,将缺损耳郭后缘皮肤与耳后乳突区切口缝合,形成耳后一整体创面,将耳后皮瓣向前推进缝合于耳郭前层皮肤.Ⅰ期术后6周行Ⅱ期手术,耳后皮瓣断蒂,皮瓣折叠形成耳轮,继发创面直接缝合或另切取皮片植皮修复.结果 21例患者皮瓣全部成活,无血运障碍、感染及坏死等并发症发生.再造耳轮轮廓清晰,外形良好,再造耳与健侧基本对称.随访2个月～1年,效果良好.结论 应用耳后乳突皮瓣二期修复耳轮部分缺损是一种安全有效的办法.     

反流轴型皮瓣在头颈部的应用

头颈部组织缺损不但要修复创面,而且要与供区的皮肤色泽、质地及感觉相匹配.本文就反流轴型皮瓣的产生过程、成活机理及头颈部常用的反流轴型皮瓣解剖做一综述.     

利用颈阔肌皮瓣修复下咽后壁

颈阔筋膜皮瓣应用于头颈部领域重建外科。根据颈阔肌血流分布,血管支配的有关基础研究,于1970年确立颈阔肌皮瓣,并做为一种有明显血管的带蒂肌皮瓣被应用于头颈部重建。这种皮瓣的主要血液供给依赖颜面动脉。该皮瓣有以下几个优点:①供皮区在颈部;②取瓣时间短;③筋膜皮瓣厚度合适;④供皮部一次性修复。应用本法可以修复口腔、咽喉、颜面各部位,尤其适用于修复咽后壁肿物切除后的创面,对下咽后壁15mm以下的肿物安全切除术后修复创面亦适用,同时配合放疗或化疗。手术要点如下。1.皮肤切口和颈廓清:原则上行双侧颈廓清,把比较能保存的一侧做供     

皮瓣移植在鼻尖缺损修复中的应用探讨

烧伤、外伤、肿瘤切除等因素导致的鼻尖部缺损临床较常见。而鼻尖部解剖结构复杂，术后缺损难以直接缝合。局部皮瓣操作简单，皮瓣与周围皮肤色泽一致性佳，修复缺损后创面平整，是修复鼻部缺损最为常见的方法之一。本文重点介绍了国内外皮瓣移植修复鼻尖缺损的应用与研究进展，为临床工作提供参考。     

用鼻唇部岛状皮瓣修复鼻部缺损

本文报告使用基底在上的皮下组织蒂的鼻唇部岛状皮瓣成功地修复8例鼻部缺损的病例,并对该皮瓣的血供进行了研究。术前先按鼻部缺损的大小和形状,沿鼻唇皱襞设计一岛状皮瓣,此皮岛转位覆盖鼻部创面后应无张力。皮岛的位置决定于缺损部位和以眶下孔为枢轴的皮瓣蒂的长度。因此,对鼻侧面皮肤缺损,皮岛应设在鼻唇部带毛区以上;鼻底部、鼻小柱和鼻背部中线缺损,因需要一较长的蒂,皮岛应设在口角水平或其下方。手术沿设计的岛状皮瓣作皮肤切口,沿皮下脂肪层广泛分离掀起皮瓣,并注意保持皮瓣     

锁骨上动脉岛状皮瓣的制备与应用

锁骨上动脉岛状皮瓣是一种取自锁骨上和三角肌区的筋膜皮瓣，是术后软组织缺损修复的一项新技术。该皮瓣因与头颈部皮肤颜色、纹理、质地高度相似，以及厚度适中、无毛发覆盖、获取简单、供区并发症少等优点，成为头颈部缺损重建的理想选择。近年来对该皮瓣的解剖研究和应用日益增多，特别是其在头颈部重建中的优势逐渐被认可。为进一步推进该皮瓣在头颈外科的应用，现对锁骨上动脉皮瓣的历史、解剖、制备及应用做一综述。     

耳后带蒂皮瓣在修复耳甲腔皮肤缺损中的应用

目的介绍耳甲腔皮肤缺损中，应用耳后带蒂皮瓣修复耳甲腔皮肤缺损的方法及术后效果。方法2016年对耳甲腔良性肿物术后耳甲腔缺损的3例女性患者于耳后、乳突区，做一“乒乓球拍样”带蒂皮瓣，于耳廓根部做一隧道，将带蒂皮瓣从耳廓根部隧道穿过之后，覆盖于耳甲腔皮肤缺损处，缝合后加压包扎。结果3例患者耳后切口均Ⅰ期愈合，皮瓣颜色、质地、弹性均良好，耳甲腔外观良好，耳后供区瘢痕几乎难以察觉。结论耳后带蒂皮瓣在修复耳甲腔皮肤缺损中，简单易行，术后疗效佳，无论操作上还是美学上，都符合要求，值得临床推广应用。     

Prefabrication of composite tissue for improved tracheal reconstruction

Tracheal repair tissues were evaluated experimentally to provide an evidence-based choice for decision-making in clinical tracheal reconstruction. Tracheal reconstructive tissue was characterized as providing for vascularization, support, and/or lining. A tissue equivalent was developed in the rabbit for each of the individual tissues. The individual tissues consisted of nonepithelialized soft tissue (vascularized fascia), epithelialized tissue (vascularized fascia grafted with buccal mucosa), and supportive tissue (ear cartilage). The 3 reconstructive tissues were evaluated in 30 rabbits after repair of an anterior laryngotracheal defect. Morphometric and histologic analysis was applied to the reconstructions. After a 1-month follow-up period, defects repaired with nonepithelialized soft tissue showed healing by secondary intention and a wound that was contracted to 44% of the initial surface area of the defect. Mucosa-lined soft tissue flaps and cartilage grafts showed a less than 10% wound contraction. Compared to cartilage grafts, mucosalined soft tissue (vascularized fascia grafted with buccal mucosa) seemed preferable for clinical use, because it showed healing by primary intention. A mucosa-lined radial forearm fascia flap was used successfully in cases of restenosis after tracheal resection. One deficiency of the mucosa-lined soft tissue was the absence of supportive tissue. In cases of extensive stenosis, it might be useful to obtain additional expansion of the airway lumen by creating a convexity at the site of reconstruction. In a second set of experiments, we attempted to improve the mucosa-lined soft tissue concept by adding elastic cartilage. A composite tissue consisting of vascularized fascia, buccal mucosa, and auricular cartilage was developed. Heterotopic prefabrication of the composite tissue was essential for survival of the cartilaginous component. Additional airway lumen expansion could be obtained after heterotopic flap prefabrication. After experimental evaluation, the concept of the prefabricated composite tissue was successfully applied in a clinical case of long-segment stenosis. Experimental and clinical evidence suggests that the combination of buccal mucosa and fascia form an optimized tissue combination for tracheal reconstruction. This combination can be improved by adding strips of autologous ear cartilage.     

The palatal island flap for reconstruction of palatal and retromolar trigone defects revisited.

BACKGROUND: Although a host of local soft tissue flaps have been described for the reconstruction of postoperative palatal defects, tissue-borne palatal obturators remain the most common form of rehabilitation of these defects. The palatal island flap, first applied to the reconstruction of the retromolar trigone and palatal defects, was first described by Gullane and Arena in 1977. This single-staged mucoperiosteal flap offers a reliable source of regional vascularized soft tissue that obviates the need for prosthetic palatal rehabilitation. OBJECTIVE: To describe a series of 5 cases in which the palatal island flap was used as a primary palatal or retromolar reconstruction. METHODS: We have retrospectively reviewed 5 consecutive cases between March 1998 and August 1999 wherein palatal island flaps were used for the primary reconstruction of postablative palatal defects. Each case was reviewed for primary pathologic findings, postoperative wound complications, postoperative speech and swallowing, and donor site morbidity. Selection of this reconstructive technique was based on the size and location of the defect and the assessment by the surgeon that the arc of rotation and amount of residual palatal mucosa were appropriate. RESULTS: Six local palatal island flaps were performed on 5 patients who had not undergone irradiation (1 patient underwent bilateral flaps). The primary pathologic findings included T1 N0 squamous cell carcinoma, T4 N0 squamous cell carcinoma, T2 N0 low-grade mucoepidermoid carcinoma, pigmented neurofibroma, and T2 N0 low-grade clear cell carcinoma. All of the lesions were located on the hard or soft palate or the retromolar trigone, and the average defect size was 7.2 cm(2). All 5 patients began an oral diet between postoperative days 1 and 5 (mean, 2 days), and all patients were discharged home without postoperative donor site or recipient site complications between days 1 and 6 (mean, 3 days). Donor site reepithelialization was complete by 4 weeks in all 5 patients. CONCLUSIONS: The palatal island flap offers a reliable method of primary reconstruction for limited lesions of the retromolar trigone and hard and soft palate. The mucoperiosteal tissue associated with this flap is ideal for partitioning the oral and nasal cavities and obviates the need for prosthetic palatal obturation.     

Management of radiation-induced tracheocutaneous tissue defects by transplantation of an ear cartilage graft and deltopectoral flap

Patients suffering from head and neck cancer often require temporary tracheostomy during therapy. The tracheostomy can usually be closed when postoperative swelling decreases and swallowing ability recovers. However, some patients, especially after adjuvant radiotherapy, may develop severe chronic wounds resulting in persistent tracheocutaneous fistula. Local wound care and plastic reconstruction strategies are required in such cases. We present two patients with head and neck cancer treated with primary surgical regimen including temporary tracheostomy and adjuvant radiotherapy. Both patients developed a persistent, poorly healing wound with persistent tracheocutaneous tissue defect. After local debridement and wound care, the peristomal necrotic tissue was excised down to the level of the trachea. The defect of the anterior tracheal wall was closed with a autogenous ear cartilage graft. The graft was harvested from the cavum conchae and sutured to the tracheal defect. The soft tissue defect was covered by transposition of a well-vascularized, fasciocutaneous deltopectoral flap. In both cases, the flaps healed satisfactorily. The donor defect was closed primarily. Complications were not observed in these two cases. A flexible tracheo-bronchoscopy showed no stenosis of the trachea at the site of cartilage graft transplantation. In conclusion, treatment of persistent radiated tracheocutaneous defects by cartilage graft and deltopectoral flap turned out to be a safe and reliable procedure which can be performed as a one-stage method with low morbidity at the donor site.     

The pectoralis myocutaneous flap for salvage of necrotic wounds

The authors have utilized six pectoralis major myocutaneous flaps in attempts to salvage extensive necrotic wounds of the pharynx and neck. The flap was employed in the following situations: massive necrosis of the entire neck skin with both carotid artery systems exposed, radiation necrosis of the neck skin with exposure of carotid artery, dehiscence of gastric pull-up from pharynx with resultant carotid exposure, failed trapezius flap in a radionecrotic oral cavity, and two cases of pharyngocutaneous fistula with extensive soft tissue necrosis. These flaps achieved healing in all cases. One death occurred 3 weeks following complete cutaneous healing secondary to a ruptured carotid pseudoaneurysm. One flap underwent total skin loss but the entirety of the muscle survived and the fistula was successfully closed with the back of the muscle being subsequently skin grafted. One case of dehiscence of the flap from oral mucosa resulted in a minor exposure of mandible with limited osteoradionecrosis controlled by topical means. This flap has performed extremely well in these precarious and difficult situations that previously may not have been salvageable. It has also been effective in abbreviating the required hospitalization and wound care. We conclude that the pectoralis myocutaneous flap should be the primary choice for the management of extensive postsurgical wound necrosis.     

Use of the levator scapulae muscle flap in head and neck reconstruction

There are numerous techniques available for reconstruction of defects following composite resection of oral cavity and oropharyngeal tumors. No single technique is applicable in all situations. The levator scapulae muscle flap is well known for its application in carotid protection. Little attention is paid to its usefulness in other aspects of head and neck reconstruction. We have been using the levator scapulae muscle flap for a variety of reconstructive problems. The flap is useful for buttressing intraoral suture lines, closing intraoral defects, and providing soft tissue to fill in dead spaces and bulk out lateral and anterior oral defects. The levator flap was found to be easy to elevate, safe, and reliable with a minimum of wound complications. A review of 18 patients, representative case studies, and a discussion of surgical technique and relevant anatomy and blood supply is presented.     

One-stage reconstruction following resection of oropharyngeal carcinoma]

Fifty-nine cases undergone one-stage reconstruction following radical resection for oropharyngeal carcinoma were reviewed. Pectoralis major myocutaneous flap has been our first choice for reconstruction of surgical defects. A composite repair with forehead island flap and mucosal flap of the posterior pharyngeal wall for defect of the total soft palate was recommended. Preoperative radiation had some influence on wound healing. The 3 and 5 year survival rates were 58.1% and 41.7% respectively, and the cosmetic and functional restorations were satisfactory in most patients operated.     

双软组织血管瓣填塞乳突术腔的临床研究

目的 探讨耳后双软组织血管瓣乳突术腔填塞应用于开放式乳突根治术的临床疗效和意义。方法 胆脂瘤中耳乳突炎患者98例(98耳),在施行开放式乳突根治术基础上,治疗组52例(52耳)应用耳后双软组织血管瓣填塞乳突腔;对照组46例(46耳)应用带血管蒂的颞肌筋膜瓣填塞乳突术腔。结果 治疗组与对照组的干耳时间分别为(17.07±1.28)d和(22.96±6.21)d,治疗组干耳时间明显短于对照组,差异有统计学意义(P<0.05)。结论 耳后区双软组织血管瓣乳突术腔填塞术应用于开放式乳突根治术,有以下优点:①面积更宽广,可最大限度地覆盖术腔骨面;②可加快术腔上皮化,缩短术后干耳时间;③术后基本无需乳突术腔清理。     

双软组织血管瓣填塞乳突术腔的临床研究

目的 探讨耳后双软组织血管瓣乳突术腔填塞应用于开放式乳突根治术的临床疗效和意义。方法 胆脂瘤中耳乳突炎患者98例(98耳),在施行开放式乳突根治术基础上,治疗组52例(52耳)应用耳后双软组织血管瓣填塞乳突腔;对照组46例(46耳)应用带血管蒂的颞肌筋膜瓣填塞乳突术腔。结果 治疗组与对照组的干耳时间分别为(17.07±1.28)d和(22.96±6.21)d,治疗组干耳时间明显短于对照组,差异有统计学意义(P<0.05)。结论 耳后区双软组织血管瓣乳突术腔填塞术应用于开放式乳突根治术,有以下优点:①面积更宽广,可最大限度地覆盖术腔骨面;②可加快术腔上皮化,缩短术后干耳时间;③术后基本无需乳突术腔清理。     

岛状皮瓣、筋膜瓣在修复颌面部软组织缺损中的应用

目的 :探讨岛状皮瓣、筋膜瓣在头颈部软组织缺损修复中的作用。方法 :根据缺损部位、范围、形态 ,选择轴型岛状皮瓣或随意型皮下蒂岛状皮瓣修复头皮、眼睑、鼻、耳廓、面部和口腔软组织缺损4 2例。结果 :4 1例获得满意的外观和功能 ,1例皮瓣部分坏死。结论 :用岛状皮瓣、筋膜瓣修复头面部软组织缺损能取得良好的临床效果。