Ashtiani Abass Kazemi, Emami Seyed Abolhassan, Rasti Madjid
Department of Plastic Surgery, Iran University of Medical Sciences, Hazrat Fatemeh Hospital, Tehran, Iran.
Plast Reconstr Surg. 2005 Aug;116(2):381-6; discussion 387-8. doi: 10.1097/01.prs.0000142475.63276.87.
Palatal fistulas occur most commonly as a complication of cleft palate surgery. Treatment of these fistulas, especially when they are wide and scarred, is a challenge for both patients and plastic surgeons, with a high rate of recurrence.
The authors have operated on 22 cases of wide, scarred, recurrent palatal fistula with the use of the facial artery musculomucosal flap, first introduced by Pribaz et al. in 1992. The patients were operated on from March of 2001 to December of 2002 and ranged in age from 2 to 21 years. This flap is axial, centered over the facial artery, and can be raised inferiorly based or superiorly based. All of these patients with cleft palate had been operated on before. In one case, because of a very wide fistula, a bilateral facial artery musculomucosal flap was used.
There were two cases of partial necrosis and one case of complete failure, probably caused by twisting of the whole pedicle. The nasal lining was made using turndown flaps of the fistula margin. Because of hanging the base of the flap (inferiorly based) and producing bite block during mastication, the pedicle had to be divided and the flap inset secondarily 1 month later.
The facial artery musculomucosal flap is an alternative for closing the scarred, wide, recurrent fistula, and is associated with a high rate of success. The flap should be included among the techniques of any plastic surgeon who performs palatal surgery.
腭瘘最常见于腭裂手术并发症。治疗这些瘘管，尤其是当它们宽大且有瘢痕时，对患者和整形外科医生来说都是一项挑战，复发率很高。
作者采用1992年由普里巴兹等人首次介绍的面动脉肌黏膜瓣，对22例宽大、有瘢痕、复发性腭瘘患者进行了手术。患者于2001年3月至2002年12月接受手术，年龄在2至21岁之间。该皮瓣为轴型，以面动脉为中心，可采用蒂在下或蒂在上的方式掀起。所有这些腭裂患者此前均已接受过手术。在1例患者中，由于瘘管非常宽大，使用了双侧面动脉肌黏膜瓣。
有2例部分坏死，1例完全失败，可能是由于整个蒂扭转所致。鼻内衬采用瘘缘翻转瓣制作。由于皮瓣蒂在下悬吊且在咀嚼时产生咬合阻挡，不得不将蒂切断，1个月后二期植入皮瓣。
面动脉肌黏膜瓣是闭合瘢痕性、宽大、复发性瘘管的一种选择，成功率较高。该皮瓣应纳入任何进行腭部手术的整形外科医生的技术范围。
