累及鼻窦的面部复杂缺损创面的修复方法及其临床效果

梁鹏飞; 许喜生; 张丕红; 毕长龙; 章华; 黄覛韬; 何志友; 曾纪章; 黄云; 李佳; 崔旭; 周思拓; 张明华; 黄晓元

doi:10.3760/cma.j.cn501225-20221130-00520

累及鼻窦的面部复杂缺损创面的修复方法及其临床效果

doi: 10.3760/cma.j.cn501225-20221130-00520

1.
中南大学湘雅医院烧伤整形外科，长沙　　410008
2.
郴州市第一人民医院烧伤整形科，郴州　　423099
3.
中南大学湘雅医院神经外科，长沙　　410008
4.
中南大学湘雅医院耳鼻咽喉头颈外科，长沙　　410008

基金项目:

国家自然科学基金面上项目 81974287

详细信息

通讯作者:
许喜生，Email：czyyxxs@126.com

张丕红，Email：zphong@aliyun.com

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出版历程
- 收稿日期: 2022-11-30

Repair methods of complex facial defect wounds involving paranasal sinuses and their clinical effectiveness

1.
Department of Burns and Plastic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
2.
Department of Burns and Plastic Surgery, Chenzhou First People's Hospital, Chenzhou 423099, China
3.
Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha 410008, China
4.
Department of Otolaryngology-Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha 410008, China

Funds:

General Program of National Natural Science Foundation of China 81974287

More Information

Corresponding author: Xu Xisheng, Email: czyyxxs@126.com; Zhang Pihong, Email: zphong@aliyun.com

摘要

摘要: 目的探讨累及鼻窦的面部复杂缺损创面的修复方法与临床效果。方法采用回顾性观察性研究方法。2020年1月—2022年5月，中南大学湘雅医院烧伤整形外科收治5例、郴州市第一人民医院烧伤整形科收治4例符合入选标准的累及鼻窦的面部复杂缺损创面患者，其中男6例、女3例，年龄35~69岁，包括4例钛网外露伴鼻窦损伤患者及5例肿瘤累及鼻窦患者。多学科团队合作充分评估损伤情况后，对钛网外露患者行钛网去除、鼻窦清创、鼻窦黏膜去除，对肿瘤患者行肿瘤根治性切除，术后皮肤软组织缺损面积为5.0 cm×2.5 cm~18.0 cm×7.0 cm、鼻窦前壁缺损/缺如面积为3 cm×2 cm~6 cm×4 cm、窦腔深1~4 cm。根据旋股外侧动脉降支的穿支走行情况，移植股前外侧嵌合皮瓣或股前外侧肌皮瓣（皮瓣面积9 cm×4 cm~19 cm×8 cm、肌肉大小5 cm×3 cm×3 cm~11 cm×6 cm×3 cm）修复缺损，将供区创面直接缝合。观察术中移植组织瓣类型、受区血管、血管吻合方式以及术后供受区恢复情况、并发症发生情况，随访受区外观与血运以及溃疡、肿瘤复发情况。结果对6例患者行股前外侧肌皮瓣移植，对3例患者行股前外侧嵌合皮瓣移植。受区血管为面动静脉者3例、为颞浅动静脉者6例，对2例患者采用血流桥接方式桥接组织瓣中血管与颞浅动静脉，7例患者行供受区血管端端吻合。术后组织瓣全部成活，面部缺损创面得到良好修复，无脑脊液漏或鼻窦分泌物漏出，无颅内感染发生，供区创面均愈合良好。术后随访6~35个月，所有患者受区血运良好，外形可；4例钛网外露患者溃疡无复发，5例肿瘤患者无局部肿瘤复发或转移。结论在充分评估面部创面所累及鼻窦范围和缺损性质的基础上，采用股前外侧肌皮瓣或股前外侧嵌合皮瓣移植修复面部伴鼻窦开放的复杂缺损创面，可获得较佳的临床效果。
- 创伤和损伤 /
- 肿瘤 /
- 面部 /
- 鼻窦 /
- 显微外科手术 /
- 外科皮瓣 /
- 创面修复
Abstract: Objective To explore the repair methods of complex facial defect wounds involving paranasal sinuses and their clinical effectiveness. Methods A retrospective observational study was conducted. From January 2020 to May 2022, 5 patients admitted to the Department of Burns and Plastic Surgery of Xiangya Hospital of Central South University and 4 patients admitted to the Department of Burns and Plastic Surgery of Chenzhou First People's Hospital with complex facial defect wounds involving paranasal sinuses met the inclusion criteria, including 6 males and 3 females, aged 35-69 years, including 4 patients with titanium mesh exposure combined with paranasal sinuses injury and 5 patients with tumor involving paranasal sinuses. After an adequate assessment of the damage by a multiple discipline team, titanium mesh removal, paranasal sinus debridement, and paranasal sinus mucosa removal were performed in patients with exposed titanium mesh, and radical tumor resection was performed in patients with tumors, with postoperative skin and soft tissue defects areas of 5.0 cm×2.5 cm to 18.0 cm×7.0 cm, anterior paranasal sinus wall defects/absence areas of 3 cm×2 cm to 6 cm×4 cm, and sinus cavity depths of 1 to 4 cm. Depending on the perforator course of the descending branch of the lateral circumflex femoral artery, the anterolateral femoral chimeric flap or anterolateral femoral myocutaneous flap (with flap area of 9 cm×4 cm to 19 cm×8 cm, muscle size of 5 cm×3 cm×3 cm to 11 cm×6 cm×3 cm) was transplanted to repair the defect, and the donor site wound was sutured directly. The type of tissue flap transplanted, the blood vessel of the recipient area, and the vascular anastomosis way during the operation, the recovery of the donor and recipient areas and the occurrence of complications after operation were observed. The appearance and blood supply of the recipient area and the recurrence of ulcers and tumors were followed up. Results The anterolateral femoral myocutaneous flap transplantation was performed in 6 patients, and the anterolateral femoral chimeric flap transplantation was performed in 3 patients. The blood vessels in recipient areas were facial arteries and veins in 3 cases and superficial temporal arteries and veins in 6 cases. The superficial temporal arteries and veins were bridged with blood vessels in tissue flaps by flow-through way in 2 patients, and end-to-end anastomosis of blood vessels in donor and recipient areas was performed in 7 patients. After operation, all the tissue flaps survived, and the facial defect wounds were well repaired without cerebrospinal fluid leakage or paranasal sinus secretion leakage, no intracranial infection occurred, and the wounds in donor areas were healed well. Follow-up of 6-35 months after operation showed that all the patients had good blood supply in the recipient area, and the shape was acceptable; 4 patients with exposed titanium mesh had no recurrence of ulceration, and 5 patients with tumor had no local tumor recurrence or metastasis. Conclusions Based on an adequate assessment of the extent of paranasal sinuses involved in the facial wound and the nature of the defect, good clinical effects can be achieved by using the anterolateral femoral muscle flap or the anterolateral femoral chimeric flap transplantation to repair complex facial defect wounds with open paranasal sinuses.
- Wounds and injuries /
- Neoplasms /
- Face /
- Paranasal sinuses /
- Microsurgery /
- Surgical flaps /
- Wound repair
梁鹏飞：酝酿和设计研究、实施手术、采集数据、分析/解释数据、撰写文章、获取研究经费；许喜生：酝酿和设计研究、实施研究、采集数据、分析/解释数据、对文章的知识性内容作批评性审阅；张丕红：酝酿和设计研究、实施手术、对文章的知识性内容作批评性审阅；毕长龙、章华、黄覛韬、何志友、曾纪章、黄云、李佳、崔旭、周思拓、张明华：实施手术、采集数据；黄晓元：指导手术

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1 股前外侧肌皮瓣修复例1脑外伤患者额部钛网外露伴鼻窦损伤创面的效果。1A.术前创面情况；1B.术前CT示颅骨缺损，钛网移位，额窦与外界相通呈现囊袋状；1C.术前左侧股前外侧肌皮瓣设计；1D.术中额部创面及额窦清创后游离移植股前外侧肌皮瓣；1E.创面修复术后即刻，肌皮瓣血运良好；1F.术后1年随访，额部外形可，溃疡无复发

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2 股前外侧嵌合皮瓣修复例2鳞状细胞癌患者上颌部洞穿性缺损并筛窦窦腔开放创面的结果。2A.术前创面情况；2B.术前三维CT示右侧上颌骨、部分鼻骨、部分颧骨、部分筛骨及眶下壁缺损；2C.术前采用三维打印技术测量缺损大小（上方大图为三维打印的面部立体结构图，左下小图为组织缺损外侧面，右下小图为组织缺损内侧面）；2D.术中清创后见颌面部洞穿性缺损与口腔、鼻腔相通；2E.左侧股前外侧嵌合皮瓣切取；2F.将皮瓣设计分为3段；2G.自上唇中央绕右侧鼻底、鼻唇沟至创面切开面部皮肤软组织，暴露鼻腔和口腔，将嵌合皮瓣移植于颌面部缺损处；2H.创面修复术后即刻，皮瓣血运良好；2I.术后随访10个月，皮瓣修复处外形可

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