Nişanci Mustafa, Türegün Murat, Er Ergin, Sengezer Mustafa
Department of Plastic and Reconstructive Surgery, Gülhane Military Medical Academy, Etlik 06018 Ankara, Turkey.
Ann Plast Surg. 2003 Sep;51(3):301-7. doi: 10.1097/01.SAP.0000054248.59489.CA.
A 23-year-old man sustained massive maxillofacial destruction from a close-range, high-velocity gunshot injury. The devastating nature of the injury led to extensive soft-tissue and bone loss involving nearly the total middle and lower portions of his face, including the deeper anatomic structures. Reconstruction of this extraordinarily extensive and three-dimensional defect was accomplished by simultaneous transfer of three free flaps during one session. A specially designed radial forearm flap replaced the internal lining and external cover of the nose, a large fibular osteocutaneous flap restored the lower face, and a second fibular osteocutaneous flap harvested from the other leg restored the midface. The second fibular flap was revascularized by combining it with the first one in a flow-through manner, and its pedicle vessels were anastomosed to the distal ends of the vessels of the first flap. Dorsal nasal reconstruction with an expanded paramedian forehead flap, commissurotomy, and intraoral flap debulking were additional procedures performed to improve cosmetic and functional outcome during the following 1-year period. Along with a radial forearm flap, combined use of bilateral osteocutaneous fibular flaps provided simultaneous, single-stage reconstruction of a huge facial defect involving both the lower and middle face with an acceptable result.
一名23岁男性因近距离高速枪伤导致颌面部严重毁损。损伤的毁灭性性质导致广泛的软组织和骨质缺损，几乎累及面部中下部分的全部，包括更深层的解剖结构。通过在一次手术中同时移植三个游离皮瓣，完成了对这一极其广泛的三维缺损的重建。一个特别设计的桡侧前臂皮瓣替代了鼻内衬和外覆组织，一个大型腓骨骨皮瓣修复了下脸，从另一条腿获取的第二个腓骨骨皮瓣修复了中脸。第二个腓骨皮瓣通过与第一个以血流通过的方式联合进行血管再通，其蒂血管与第一个皮瓣血管的远端进行吻合。在随后的1年期间，还进行了额外的手术，包括用扩张的正中旁前额皮瓣进行鼻背重建、口角切开术和口内皮瓣减容术，以改善美容和功能效果。除了桡侧前臂皮瓣外，联合使用双侧腓骨骨皮瓣能够同时、一期重建涉及面中下部的巨大面部缺损，效果尚可。
