Neurovascularized Free Short Head of the Biceps Femoris Muscle Transfer for One-Stage Reanimation of Facial Paralysis
Neurovascularized Free Short Head of the Biceps Femoris Muscle Transfer for One-Stage Reanimation of Facial Paralysis
复制标题
股二头肌神经血管化游离短头肌肉移植用于面瘫一期复活
DOI：
10.1097/01.prs.0000149405.89201.9e
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发表时间：
2005
影响因子：
3.6
通讯作者：
Y. Maruyama
中科院分区：
文献类型：
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作者：
A. Hayashi;Y. Maruyama
无需神经移植即可对瘫痪面部进行跨面复苏的单阶段技术是对两阶段手术的改进，因为它可以使转移的肌肉及早重新神经支配并缩短康复时间。在解剖学研究的基础上，附着有大腿外侧肌间隔的股二头肌短头被确定为微神经血管游离肌肉移植的新候选者。作者对股二头肌短头和长运动神经进行了一期转移，使 7 名患者的面瘫恢复活力。六名患者的短头的主要营养血管是深穿支（第二或第三），一名患者的腘血管的直接分支。在所有情况下，受体血管都是面部血管。短头运动神经长度10～16cm，6例直接缝合对侧面神经的几个颧支和颊支。一名患者需要 3 厘米的插入神经移植物才能到达完整一侧的合适面神经分支。移植后的肌肉初始自主运动所需的时间为手术后 4 至 10 个月。术后随访时间为5至42个月。股二头肌血管化神经支配的短头的转移被认为是瘫痪面部一期重建的一种替代方法，因为该肌肉具有可靠的血管解剖结构，并且它允许两个团队一起手术而无需重新定位患者。股二头肌短头的神经进入肌腹血管蒂的相对侧，血管蒂与运动神经的这种独特关系在解剖学上适合瘫痪面部的一期重建。可以收获长达 16 厘米的神经，并且几乎在所有情况下神经都足够长，可以到达对侧完整的面神经。附着在短头上的外侧肌间隔提供了“锚定/缝合支撑”组织，从而可以实现对颧骨以及上唇和下唇的可靠固定。此外，供体部位的疤痕和畸形是可以接受的，并且该肌肉的损失不会导致供体部位功能障碍。
The single-stage technique for cross-face reanimation of the paralyzed face without nerve graft is an improvement over the two-stage procedure because it results in early reinnervation of the transferred muscle and shortens the period of rehabilitation. On the basis of an anatomic investigation, the short head of the biceps femoris muscle with attached lateral intermuscular septum of the thigh was identified as a new candidate for microneurovascular free muscle transfer. The authors performed one-stage transfer of the short head of the biceps femoris muscle with a long motor nerve for reanimation of established facial paralysis in seven patients. The dominant nutrient vessels of the short head were the profunda perforators (second or third) in six patients and the direct branches from the popliteal vessels in one patient. The recipient vessels were the facial vessels in all cases. The length of the motor nerve of the short head ranged from 10 to 16 cm, and it was sutured directly to several zygomatic and buccal branches of the contralateral facial nerve in six patients. One patient required an interpositional nerve graft of 3 cm to reach the suitable facial nerve branches on the intact side. The period required for initial voluntary movement of the transferred muscles ranged from 4 to 10 months after the procedures. The period of postoperative follow-up ranged from 5 to 42 months. Transfer of the vascularized innervated short head of the biceps femoris muscle is thought to be an alternative for one-stage reconstruction of the paralyzed face because of the reliable vascular anatomy of the muscle and because it allows two teams to operate together without the need to reposition the patient. The nerve to the short head of the biceps femoris enters the side opposite the vascular pedicle of the muscle belly, and this unique relationship between the vascular pedicle and the motor nerve is anatomically suitable for one-stage reconstruction of the paralyzed face. As much as to 16 cm of the nerve can be harvested, and the nerve is long enough to reach the contralateral intact facial nerve in almost all cases. The lateral intermuscular septum, which is attached to the short head, provides “anchor/suture-bearing” tissue, allowing reliable fixations to the zygoma and the upper and lower lips to be achieved. In addition, the scar and deformity of the donor site are acceptable, and loss of this muscle does not result in donor-site dysfunction.
Maruyama，Y.：“鼻重建的单元方法”整形重建外科。
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