Saadeh Pierre B, Chang Christopher C, Warren Stephen M, Reavey Patrick, McCarthy Joseph G, Siebert John W
New York, N.Y. From the Institute of Reconstructive Plastic Surgery, New York University School of Medicine.
Plast Reconstr Surg. 2008 Jun;121(6):368e-378e. doi: 10.1097/PRS.0b013e3181707194.
Since their first review of microsurgical correction of facial contour deformities in 19 patients with craniofacial malformations, the authors have treated an additional 74 patients (n = 93). The authors review indications, choices, safety, efficacy, complications, and technical refinements. A treatment algorithm is presented.
A retrospective chart review of all patients who underwent microvascular reconstruction of the face and all patients with craniofacial dysmorphology was performed. Between 1989 and 2004, a total of 93 patients with the following diagnoses were identified: craniofacial microsomia (n = 73), Treacher Collins syndrome (n = 8), and severe orbitofacial cleft (n = 12). All patients underwent microsurgical facial reconstruction with a superficial inferior epigastric, groin, or circumflex scapular flap. Flap revisions, complications, and non-free flap related surgery were reviewed.
The mean age at microvascular reconstruction was 11 years (range, 4 to 27 years). Flap choices included the following: superficial inferior epigastric (n = 4), groin (n = 3), and circumflex scapular (n = 105). Seventy-six patients underwent unilateral and 17 patients underwent bilateral (one of 17 simultaneous) reconstructions. Postoperative complications included partial flap loss (n = 1), reexploration (n = 1), hematoma (n = 5), and cellulitis (n = 5). All patients had subjective improvement in facial contour, symmetry, skin tone, and color. Most patients underwent additional non-free flap procedures including mandibular distraction and ear reconstruction.
Microsurgical flaps have markedly improved the authors' ability to restore craniofacial contour in patients with craniofacial malformations. In selected patients, the authors choose primary midface augmentation with free vascularized tissue to restore form and function. Microsurgical flaps in patients with craniofacial malformations are safe, effective, and reliable.
自首次对19例颅面畸形患者进行面部轮廓畸形的显微外科矫正以来，作者又治疗了另外74例患者（n = 93）。作者回顾了适应证、选择、安全性、疗效、并发症及技术改进。并给出了一种治疗算法。
对所有接受面部微血管重建的患者以及所有颅面畸形患者进行回顾性病历审查。在1989年至2004年期间，共确定了93例患有以下诊断的患者：颅面短小畸形（n = 73）、特雷彻·柯林斯综合征（n = 8）和严重眶面裂（n = 12）。所有患者均采用腹壁浅下、腹股沟或旋肩胛皮瓣进行显微外科面部重建。回顾了皮瓣修复、并发症及非游离皮瓣相关手术。
微血管重建的平均年龄为11岁（范围4至27岁）。皮瓣选择包括：腹壁浅下（n = 4）、腹股沟（n = 3）和旋肩胛（n = 105）。76例患者接受了单侧重建，17例患者接受了双侧（17例中的1例同时进行）重建。术后并发症包括部分皮瓣坏死（n = 1）、再次探查（n = 1）、血肿（n = 5）和蜂窝织炎（n = 5）。所有患者在面部轮廓、对称性、肤色和颜色方面均有主观改善。大多数患者还接受了包括下颌骨牵张和耳部重建在内的额外非游离皮瓣手术。
显微外科皮瓣显著提高了作者修复颅面畸形患者颅面轮廓的能力。在选定的患者中，作者选择用游离带血管组织进行一期面中部增大术以恢复形态和功能。颅面畸形患者的显微外科皮瓣安全、有效且可靠。
