Revascularized tissue transfer for the repair of complex midfacial defects in oncologic patients.
Revascularized tissue transfer for the repair of complex midfacial defects in oncologic patients.
复制标题
血运重建组织移植用于修复肿瘤患者复杂的面中部缺损。
DOI：
10.1053/joms.2000.16616
复制
发表时间：
2000
影响因子：
1.9
通讯作者：
H. Schliephake
中科院分区：
文献类型：
--
作者：
H. Schliephake
目的
本研究回顾了作者使用血运重建组织移植修复肿瘤患者复杂的面中部缺损的经验。
患者和方法
对 1991 年至 1999 年间接受血管化组织修复联合骨骼和软组织缺损的 15 名肿瘤患者进行了回顾。平均术后间隔为50.2个月。单纯血管化软组织修复1例，骨皮肩胛骨移植1例，血管化软组织+非血管化骨移植3例。 3例采用血管化软组织移植后进行无血管化骨二次重建，其余7例采用复合皮瓣进行血管化二次重建。检查患者口鼻或口窦穿孔的闭合情况以及中面部轮廓的恢复情况。结果分为好、一般和差，并且与修复的类型和时间相关。
结果
发生 1 个皮瓣丢失，并抢救了 1 个受损皮瓣。血管化软组织移植后的二次非血管化骨骼重建容易受到空隙引起的感染并发症的影响，并且它们不能在高阶缺陷中提供足够的骨骼轮廓。据估计，9 名患者的轮廓恢复良好，3 名患者的轮廓恢复良好，3 名患者的轮廓恢复较差。较差的结果仅限于二次重建。
结论
结论是应尽可能以中面部框架的骨骼修复为主。如果可以保留眼眶框架，仅通过血管化软组织进行初步修复可能就足够了，然后用非血管化骨移植物对牙槽嵴进行二次修复。根据 Wells 和 Luce 的说法，复杂的 IV 型和 V 型中面部缺损需要多步骤程序才能完成中面部重建的所有目标。
PURPOSE
This study reviews the author's experience with revascularized tissue transfer for the repair of complex midfacial defects in oncologic patients.
PATIENTS AND METHODS
Fifteen oncologic patients who had received vascularized tissue repair of combined skeletal and soft tissue defects during 1991 to 1999 were reviewed. The mean postoperative interval was 50.2 months. Primary reconstruction was accomplished by vascularized soft tissue repair alone in 1 case, an osteocutaneous scapula graft in 1 case, and by vascularized soft tissue and nonvascularized bone grafts in 3 cases. Secondary reconstruction with nonvascularized bone after vascularized soft tissue transfer was done in 3 cases, and vascularized secondary reconstructions with composite flaps were performed in the remaining 7 cases. Patients were examined for closure of oronasal or oroantral perforations and restoration of midfacial contour. The results were categorized as good, fair, and poor, and were related to the type and timing of the restoration.
RESULTS
One flap loss was encountered and one compromised flap was salvaged. Secondary nonvascularized skeletal reconstructions after vascularized soft tissue transfer were susceptible to infectious complications caused by voids, and they did not provide adequate skeletal contour in higher-order defects. Contour restoration was estimated to be good in 9 patients, fair in 3, and poor in 3. Poor results were limited to secondary reconstructions.
CONCLUSION
It is concluded that the skeletal repair of the midface frame should be done primarily, as far as possible. If the orbital frame can be preserved, primary repair by vascularized soft tissue alone may be sufficient, with secondary restoration of the alveolar crest with nonvascularized bone grafts. Complex midfacial defects of types IV and V according to Wells and Luce require multistep procedures to accomplish all goals of midfacial reconstruction.