摘要
目的探讨CT血管造影三维重建技术辅助股前外侧皮瓣个体化设计在修复口腔颌面部恶性肿瘤术后软组织缺损中的应用效果。方法自2016年2月至2018年6月,采用游离股前外侧皮瓣修复口腔颌面部恶性肿瘤术后软组织缺损患者14例,其中舌癌9例,颊癌5例。术前对供区行CTA检查,通过三维重建技术获得股前外侧皮瓣供区血管解剖的三维可视化模型;评估、挑选、定位优势穿支血管,结合口腔颌面部缺损的具体形状和范围,以穿支穿出点为中心进行皮瓣个体化设计。术中扩大切除原发灶后软组织缺损范围为6.0cm×4.5cm^8.0cm×6.0cm,股前外侧皮瓣面积为7.5cm×5.5cm^10.0cm×6.0cm。结果14例患者术前CTA定位的优势穿支血管的走行、起源和穿出点位置等,与术中所见一致,皮瓣全部成活。供区及受区伤口均一期愈合。术后随访3~12个月,平均5个月,皮瓣血运良好,外形不臃肿,患者咀嚼、吞咽及发音功能均获得良好恢复;供区未出现感觉异常及运动障碍。结论术前通过CTA三维重建技术评估,定位优势穿支血管,辅助股前外侧皮瓣个体化设计,制定精确的皮瓣切取手术方案,能有效提高皮瓣切取手术的成功率,降低手术难度和风险,获得理想的口腔颌面部形态及功能修复效果,具有较高的临床应用价值。
Objective To explore the efficacy of an individualized design utilizing the anterolateral thigh flap assisted by CTA three-dimensional reconstruction in the repair of postoperative soft tissue defects in oral and maxillofacial malignant tumors.Methods From February 2016 to June 2018, 14 patients with soft tissue defects after oral and maxillofacial malignant tumor ablation were repaired with free anterolateral thigh flap. Among these patients, there were 9 cases of tongue cancer and 5 cases of buccal cancer.CTA was performed on the donor site before the operation, and a three-dimensional visualization model of the vascular anatomy of the anterolateral thigh flap was obtained by a three-dimensional reconstruction technique. The superior perforator vessels were evaluated, selected, and located and the specific shape and extent of the oral and maxillofacial defects were combined. Individualized flaps centering on the perforator penetrating point were designed. The area of soft tissue defect after the primary lesion ablation was from 6.0 cm×4.5 cm to 8.0 cm×6.0 cm, and the area of anterolateral thigh flap was from 7.5 cm×5.5 cm to 10.0 cm×6.0 cm. The donor area was directly sewed and stitched. Results The direction, origin and location of the superior perforator vessels were selected according to the results of CTA examination, consistent with the intraoperative findings. All the anterolateral tuigh flap survived. The wounds in the donor and recipient areas were healed in the first stage. The patients were followed up from 3 to 12 months, with an average of 5 months. The flaps had good blood supply, and the shape was not swollen. The chewing, swallowing, and pronunciation functions of patients were well recovered. No abnormal sensations or movement disorders occurred in the donor site. Conclusion The superior perforator was evaluated and located by CTA three-dimensional reconstruction technique preoperative. The CTA three-dimensional reconstruction technique was helpful to individualize the design of the anterola
作者
盛美樱
肖灿
贾玉静
邵学垒
SHENG Mei-ying;XIAO Can;JIA Yu-jing;SHAO Xue-lei(Department of Burn Burn and plastic Surgery,The First Affiliated Hospitalof Soochow University,Suzhou 215006,China)
出处
《中国美容整形外科杂志》
CAS
2019年第6期348-352,共5页
Chinese Journal of Aesthetic and Plastic Surgery
关键词
股前外侧皮瓣
CTA三维重建技术
口腔颌面部恶性肿瘤
软组织缺损
Anterolateral thigh flap
CTA three-dimensional reconstruction technique
Oral and maxillofacial malignant tumors
Soft tissue defect
