Yazici Ilker, Unal Sakir, Siemionow Maria
Cleveland, Ohio From the Department of Plastic Surgery, The Cleveland Clinic Foundation.
Plast Reconstr Surg. 2006 Nov;118(6):1321-1327. doi: 10.1097/01.prs.0000239452.31605.b3.
Extensive craniomaxillofacial deformities including bone and soft-tissue defects are always challenging for reconstructive surgeons. The purpose of this study was to extend application of the face/scalp transplantation model in the rat by incorporation of the vascularized calvarial bone, based on the same vascular pedicle, as a new treatment option for extensive craniomaxillofacial deformities with large bone defects.
Seven composite hemiface/calvaria transplantations were performed across major histocompatibility complex barrier between Lewis-Brown Norway and Lewis rats. Seven donor and seven recipient rats were used in this study. Hemicalvarial bone and face grafts were dissected on the same pedicle of the common carotid artery and jugular vein and were transplanted to the deepithelialized donor faces. All rats received tapered and continuous doses of cyclosporine A monotherapy. Evaluation methods included flap angiography, daily inspection, computed tomographic scan, and bone histology.
Flap angiography demonstrated the vascular supply of the bone. The average survival time was 154 days. There were no signs of rejection and there was no flap loss noted at 220 days posttransplantation. Bone histology at days 7, 30, 63, and 100 after transplantation revealed viable bone at all time points, and computed tomographic scans taken at days 14, 30, and 100 revealed normal bones without resorption.
For extensive face deformities involving large bone and soft-tissue defects, this new osteomusculocutaneous hemiface/calvaria flap model may serve to create new reconstructive options for covering during one surgical procedure.
包括骨骼和软组织缺损在内的广泛颅颌面畸形一直是重建外科医生面临的挑战。本研究的目的是通过纳入基于同一血管蒂的带血管蒂颅骨，扩展大鼠面部/头皮移植模型的应用，作为治疗伴有大骨缺损的广泛颅颌面畸形的一种新选择。
在Lewis-Brown Norway大鼠和Lewis大鼠之间跨越主要组织相容性复合体屏障进行了7例复合半面/颅骨移植。本研究使用了7只供体大鼠和7只受体大鼠。半颅骨和面部移植物在颈总动脉和颈静脉的同一蒂上进行解剖，并移植到去上皮化的供体面部。所有大鼠均接受环孢素A单药的逐渐减量和持续给药。评估方法包括皮瓣血管造影、每日检查、计算机断层扫描和骨组织学检查。
皮瓣血管造影显示了骨的血供。平均存活时间为154天。在移植后220天没有排斥反应的迹象，也没有皮瓣丢失的情况。移植后第7、30、63和100天的骨组织学检查显示所有时间点的骨均存活，第14、30和100天的计算机断层扫描显示骨正常，无吸收。
对于涉及大骨和软组织缺损的广泛面部畸形，这种新的骨肌皮半面/颅骨皮瓣模型可能为一次手术覆盖创造新的重建选择。
