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Volume 39 Issue 3
Mar.  2023
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Article Navigation >  CHINESE JOURNAL OF BURNS AND WOUNDS  > 2023  >  39(3): 221-227
Liang PF,Xu XS,Zhang PH,et al.Repair methods of complex facial defect wounds involving paranasal sinuses and their clinical effectiveness[J].Chin J Burns Wounds,2023,39(3):221-227.DOI: 10.3760/cma.j.cn501225-20221130-00520.
Citation: Liang PF,Xu XS,Zhang PH,et al.Repair methods of complex facial defect wounds involving paranasal sinuses and their clinical effectiveness[J].Chin J Burns Wounds,2023,39(3):221-227.DOI: 10.3760/cma.j.cn501225-20221130-00520.
shu

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

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

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    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.

     

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    • References(30)
  • [1]
    SchubertW,GearAJ,LeeC,et al.Incorporation of titanium mesh in orbital and midface reconstruction[J].Plast Reconstr Surg,2002,110(4):1022-1030; discussion 1031-1032.DOI: 10.1097/01.PRS.0000021307.23118.E7.
    [2]
    CraigJR,DeebRH.Reconstruction of anterior table frontal sinus defects with pericranial flap and titanium mesh[J].Laryngoscope,2021,131(7):1451-1454.DOI: 10.1002/lary.29296.
    [3]
    张天明,房居高,陈晓红,等.颅鼻眶联合入路切除筛窦恶性肿瘤[J].中华医学杂志,2007,87(5):304-307.DOI: 10.3760/j:issn:0376-2491.2007.05.004.
    [4]
    李晓明,宋琦,李红霞,等.游离腹直肌肌皮瓣在晚期鼻窦癌手术切除术后颅面巨大和复杂缺损修复中的应用[J].中华耳鼻咽喉头颈外科杂志,2021,56(9):907-913.DOI: 10.3760/cma.j.cn115330-20210601-00320.
    [5]
    唐举玉,贺继强,吴攀峰,等.股前外侧分叶-嵌合穿支皮瓣在四肢复杂创伤修复中的应用[J].中华显微外科杂志,2020,43(4):326-330.DOI: 10.3760/cma.j.cn441206-20190309-00089.
    [6]
    张民,姬长友,陈继川,等.鼻和鼻窦外伤的诊治体会[J].创伤外科杂志,2010,12(3):206-207.DOI: 10.3969/j.issn.1009-4237.2010.03.005.
    [7]
    陆治强,覃礼忠,张群,等.前颅底重建九例体会[J/CD].中华临床医师杂志:电子版,2013(3):1323-1324.DOI: 10.3877/cma.j.issn.1674-0785.2013.03.135.
    [8]
    中华神经外科学会神经创伤专业组,中华创伤学会神经损伤专业组,中国神经外科医师协会神经创伤专家委员会.创伤性颅骨缺损成形术中国专家共识[J].中华神经外科杂志,2016,32(8):767-770.DOI: 10.3760/cma.j.issn.1001-2346.2016.08.002.
    [9]
    KambalimathDH,SridharKR,AchuthaS.Surgical management of frontal bone fractures[J].J Craniofac Surg,2021,32(4):1472-1475.DOI: 10.1097/SCS.0000000000007394.
    [10]
    WangYT,ChenCH,WangPF,et al.Development of a novel anatomical thin titanium mesh plate with reduction guidance and fixation function for Asian zygomatic-orbitomaxillary complex fracture[J].J Craniomaxillofac Surg,2018,46(4):547-557.DOI: 10.1016/j.jcms.2017.11.009.
    [11]
    MukherjeeS,ThakurB,HaqI,et al.Complications of titanium cranioplasty--a retrospective analysis of 174 patients[J].Acta Neurochir (Wien),2014,156(5):989-998; discussion 998.DOI: 10.1007/s00701-014-2024-x.
    [12]
    秦虎,汪永新,王增亮.颅骨成形术后钛网外露的原因分析及治疗体会[J].中国临床神经外科杂志,2021,26(10):796-797.DOI: 10.13798/j.issn.1009-153X.2021.10.015.
    [13]
    MaqboolT,BinhammerA,BinhammerP,et al.Risk factors for titanium mesh implant exposure following cranioplasty[J].J Craniofac Surg,2018,29(5):1181-1186.DOI: 10.1097/SCS.0000000000004479.
    [14]
    SunQ,SohHY,ZhangWB,et al.Long-term effect of individualized titanium mesh in orbital floor reconstruction after maxillectomy[J].Laryngoscope,2021,131(10):2231-2237.DOI: 10.1002/lary.29569.
    [15]
    GellrichFF,HüningS,BeissertS,et al.Medical treatment of advanced cutaneous squamous-cell carcinoma[J].J Eur Acad Dermatol Venereol,2019,33 Suppl 8:S38-43.DOI: 10.1111/jdv.16024.
    [16]
    ParasharK,TorresAE,Boothby-ShoemakerW,et al.Imaging technologies for presurgical margin assessment of basal cell carcinoma[J].J Am Acad Dermatol,2023,88(1):144-151.DOI: 10.1016/j.jaad.2021.11.010.
    [17]
    叶子青,谢卫国,龙忠恒,等.21例瘢痕癌患者诊疗分析[J].中华烧伤杂志,2014,30(6):491-494.DOI: 10.3760/cma.j.issn.1009-2587.2014.06.006.
    [18]
    王保为,张二朋,李冰,等.复发性颌面鼻窦颅底恶性肿瘤切除并游离皮瓣修复(附九例临床报告)[J].中华耳鼻咽喉头颈外科杂志,2021,56(11):1179-1184.DOI: 10.3760/cma.j.cn115330-20210223-00082.
    [19]
    ZeidermanMR,PuLLQ.Contemporary reconstruction after complex facial trauma[J/OL].Burns Trauma,2020,8:tkaa003[2022-11-30].https://pubmed.ncbi.nlm.nih.gov/32341916/.DOI: 10.1093/burnst/tkaa003.
    [20]
    赵卫良,缪国专.外伤性脑脊液鼻漏14例开颅手术体会[J].武警医学,2017,28(4):383-385.DOI: 10.3969/j.issn.1004-3594.2017.04.018.
    [21]
    HanY,ChenY,HanY,et al.The use of free myocutaneous flap and implant reinsertion for staged cranial reconstruction in patients with titanium mesh exposure and large skull defects with soft tissue infection after cranioplasty: report of 19 cases[J].Microsurgery,2021,41(7):637-644.DOI: 10.1002/micr.30800.
    [22]
    陈黎明,刘毅,张诚,等.股前外侧嵌合穿支皮瓣修复合并深部无效腔特殊部位创面[J].中华烧伤杂志,2018,34(5):288-290.DOI: 10.3760/cma.j.issn.1009-2587.2018.05.007.
    [23]
    任高宏,吴晓虎,陈允彪,等.股前外侧嵌合穿支皮瓣修复下肢复杂软组织缺损[J].中华显微外科杂志,2020,43(5):435-440.DOI: 10.3760/cma.j.cn441206-20200325-00173.
    [24]
    臧成五,陈永祥,鲜航,等.分叶式股前外侧嵌合穿支皮瓣修复四肢复杂性软组织缺损[J].中华显微外科杂志,2022,45(3):254-259.DOI: 10.3760/cma.j.cn441206-20220208-00026.
    [25]
    杨力,蔡斌,薛君荣,等.个体化股前外侧皮瓣游离移植修复复杂难愈性创面的临床效果[J].中华烧伤杂志,2020,36(8):730-734.DOI: 10.3760/cma.j.cn501120-20190621-00281.
    [26]
    LódererZ,VerebT,PaczonaR,et al.An anterolateral thigh chimeric flap for dynamic facial and esthetic reconstruction after oncological surgery in the maxillofacial region: a case report[J].Head Face Med,2018,14(1):7.DOI: 10.1186/s13005-018-0164-6.
    [27]
    DriessenC,van HoutN,van KuppenveldP,et al.Usefulness of a template-based anterolateral thigh flap for reconstruction of head and neck defects[J].Microsurgery,2020,40(7):776-782.DOI: 10.1002/micr.30637.
    [28]
    查(韦华)光,李安民,张志文,等.背阔肌皮瓣在颅面重建中的作用[J].中华神经外科疾病研究杂志,2004,3(5):466-467.DOI: 10.3969/j.issn.1671-2897.2004.05.029.
    [29]
    张彬,万经海,张永侠,等.游离组织瓣修复晚期颅底肿瘤术后组织缺损[J].中华耳鼻咽喉头颈外科杂志,2010,45(5):406-409.DOI: 10.3760/cma.j.issn.1673-0860.2010.05.013.
    [30]
    Acero SanzJ,Ranz ColioÁ,Picón MolinaM,et al.Revascularization of the tongue by radial forearm flow-through flap[J].Int J Oral Maxillofac Surg,2021,50(3):323-326.DOI: 10.1016/j.ijom.2020.07.015.
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