Reconstruction of through-and-through osteocutaneous defects of the mouth and face with subscapular system flaps.
Reconstruction of through-and-through osteocutaneous defects of the mouth and face with subscapular system flaps.
复制标题
用肩胛下系统皮瓣重建口腔和面部的贯穿性骨皮肤缺损。
DOI：
10.1308/1478708051496
复制
发表时间：
2005
影响因子：
1.4
通讯作者：
I. Hutchison
中科院分区：
文献类型：
--
作者：
N. Kalavrezos;P. Hardee;I. Hutchison
背景
头颈部的大规模切除手术可能会造成口腔黏膜、骨骼和面部皮肤的复合性缺损。这些缺损的大表面积和三维性质提出了一个困难的重建挑战，需要足够的骨和大的，位置灵活的皮瓣。
患者和方法
自1993年9月至2000年5月，应用肩胛下动脉系统复合皮瓣修复19例口面部贯通性骨皮肤缺损。评价的参数包括：（i）组织缺损的部位和尺寸;（ii）特定皮瓣特性;（iii）受体和供体部位发病率的审查。
结果
10种肩胛骨皮瓣，8种背阔肌前锯肌和肋骨骨肌皮瓣，以及1种肩胛骨皮瓣和背阔肌肌皮瓣的组合用于修复面部复合缺损，平均尺寸为：皮肤54.4 cm（2），粘膜56.2 cm（2）和骨8.2 cm（2）。3例患者发生缺血性并发症，包括1例全皮瓣失败和1例既往接受过放疗的患者骨组件失败。第三块皮瓣成功回收。未观察到显著的长期供区发病率。
结论
以肩胛下动脉系统为基础的复合皮瓣是一种多功能的重建模式，用于口部和面部的大面积贯通性缺损。
BACKGROUND
Major ablative surgery in the head and neck region may create composite defects involving the oral mucosa, bone and the overlying facial skin. The large surface area and the three-dimensional nature of these defects pose a difficult reconstructive challenge requiring adequate bone and large, positionally versatile skin flaps.
PATIENTS AND METHODS
From September 1993 to May 2000, 19 patients with through-and-through osteocutaneous defects of the mouth and face were reconstructed with composite subscapular artery system flaps. The evaluated parameters included: (i) site and dimensions of the tissue defect; (ii) specific flap properties; and (iii) review of the recipient and donor site morbidity.
RESULTS
10 variants of scapular osteocutaneous flaps, eight latissimus dorsi with serratus anterior and rib osteo-myocutaneous flaps, and one combination of an osteocutaneous scapular and myocutaneous latissimus dorsi flap were used to reconstruct composite facial defects with mean dimensions of: skin 54.4 cm(2), mucosa 56.2 cm(2) and bone of 8.2 cm. Ischaemic complications occurred in three patients including one total flap failure and one failure of the bony component in previously irradiated patients. The third flap was successfully salvaged. No significant long-term donor site morbidity was noted.
CONCLUSION
Composite flaps based on the subscapular artery system are a versatile reconstructive modality for large through-and-through defects of the mouth and face.