Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, 17, Haengdang-Dong, Seongdong-Gu, Seoul 133-792, Republic of Korea.
J Plast Reconstr Aesthet Surg. 2011 Jul;64(7):902-10. doi: 10.1016/j.bjps.2010.11.027. Epub 2011 Jan 14.
Craniofacial contour defects are challenging to restore because they may involve multiple tissues and span several aesthetic subunits in a non-contiguous manner. Some of these deformities may be associated with significant dead space in the region of sinus and orbit. The numerous subtle contours of the craniofacial regions must be preserved or restored to achieve a pleasing outcome.
We managed six patients with various craniofacial contour deformities as a result of hemifacial microsomia, infection, post excision of venous malformation, lipodystrophy, craniectomy for chronic frontal sinusitis and infected pneumocephalus. They were reconstructed with thoracodorsal perforator flaps bearing various components, that is, adiposal, adipofascial, dermoadiposal, adipomyofascial and osteomuscular elements. Half of the flaps were in chimaeric form. The largest flap size was 11 × 17 cm. All flaps survived and no patient required secondary contouring procedure, except for cranioplasty in one patient.
The thoracodorsal perforator flap is very suitable for restoration of craniofacial contour deformities. Its advantages include: (1) ease of customisation of size and thickness, (2) several choices of donor tissue from the lateral thoracic region yielding multiple tissue components, for example, adiposal, adipofascial, dermoadiposal, adipomyofascial and osteomuscular flaps, (3) presence of adjacent perforators in the thoracodorsal system, allowing chimaeric flap configuration, thereby improving adaptation to non-contiguous contour defects, (4) ability to tailor the donor and recipient vessel size match by varying how proximal to harvest along the thoracodorsal vessels, (5) primary closure of donor site and (6) flap harvesting in supine position allowing a two-team approach.
颅面轮廓缺陷的修复具有挑战性，因为它们可能涉及多个组织，并且以非连续的方式跨越多个美学亚单位。其中一些畸形可能与窦和眶区的显著死腔有关。颅面区域的众多细微轮廓必须得到保留或恢复，以达到令人满意的效果。
我们管理了 6 名因单侧颜面发育不全、感染、静脉畸形切除后、脂肪营养不良、慢性额窦炎颅骨切除术和感染性气颅导致各种颅面轮廓畸形的患者。他们使用胸背穿支皮瓣进行重建，这些皮瓣带有各种成分，即脂肪、脂肪筋膜、真皮脂肪、脂肪肌筋膜和骨肌成分。一半的皮瓣为嵌合形式。最大的皮瓣尺寸为 11×17cm。所有皮瓣均存活，除 1 名患者需行颅骨修补术外，无患者需要进行二次轮廓整形术。
胸背穿支皮瓣非常适合修复颅面轮廓畸形。其优点包括：（1）易于定制大小和厚度；（2）可从侧胸区域选择多种供区组织，产生多种组织成分，如脂肪、脂肪筋膜、真皮脂肪、脂肪肌筋膜和骨肌皮瓣；（3）胸背系统中存在相邻穿支，允许嵌合皮瓣构型，从而改善对非连续轮廓缺陷的适应；（4）通过改变在胸背血管上的采集位置，能够调整供区和受区血管大小的匹配；（5）供区的一期闭合；（6）仰卧位皮瓣采集，允许采用双团队方法。
