Germain M A, Trotoux J, Luboinski B, Schwaab G, Marandas P, Mamelle G, Leridant A M, Julieron M, Janot F, Hureau J
Service de Chirurgie, Hôpital de Nanterre.
Chirurgie. 1991;117(3):236-43.
The free neurovascular antebrachial transplant was described by Yang-Guofan in 1978. In 1981, we brought the description of this free transplant to Europe. Forty-three antebrachial grafts were made to reconstruct the cervicocephalic extremity. We had various indications: floor of the mouth and base of the tongue: 18 cases, facial structures: 7 cases, posterior wall of the pharynx: 9 cases, rescue surgery for esophagoplasty: 6 cases, mandible: 2 cases (using a bone rod taken from the radius), internal aspect of the cheek: 1 case. All grafts were revascularized. In 41 cases, the indications were carcinological, the last 2 cases being benign lesions. The early postoperative mortality included 1 case, not related to the nature of the operation (neoplasm). There was no failure of free transplants. Surveillance was ensured every half-hour during 12 hours, then every 3 hours. Discriminating sensation was recovered in 39 of 43 cases. Mandibular bone reconstructions were knit at the 3rd month. The main disadvantage of removing this graft is esthetic, as it leaves a considerable scar on the forearm. The free antebrachial transplant provides an effective solution to the reconstructions of the cervicocephalic extremity, when a narrow, thin, supple, reinnervated, compound transplant is needed.
游离前臂神经血管移植术由杨国凡于1978年首次描述。1981年，我们将这种游离移植术的描述引入欧洲。共进行了43例前臂移植以重建头颈部位。我们有多种适应证：口底和舌根：18例，面部结构：7例，咽后壁：9例，食管成形术的挽救手术：6例，下颌骨：2例（使用取自桡骨的骨棒），颊内侧：1例。所有移植均实现了血管再通。41例的适应证为癌症，最后2例为良性病变。术后早期死亡率为1例，与手术性质（肿瘤）无关。游离移植均未失败。术后12小时内每半小时进行一次监测，之后每3小时监测一次。43例中有39例恢复了辨别感觉。下颌骨重建在第3个月时愈合。切除该移植组织的主要缺点是美观问题，因为会在前臂留下相当大的疤痕。当需要一个狭窄、薄、柔软、可重新神经支配的复合移植组织时，游离前臂移植为头颈部位的重建提供了一种有效的解决方案。
