Wada Takeshi, Nakatani Ken, Hiraishi Yukihiro, Negoro Kenji, Iwagami Yoshinobu, Fujita Shigeyuki
Department of Oral and Maxillofacial Surgery, Wakayama Medical University, Wakayama-shi, Japan.
J Oral Maxillofac Surg. 2011 Jun;69(6):1815-25. doi: 10.1016/j.joms.2010.07.069. Epub 2011 Feb 1.
Pedicle myofascial graft should be considered in contemporary oral and maxillofacial reconstruction for the following reasons: 1) the pedicle myofascial unit is reliable and easily handled; 2) on the grafted myofascia in the oral cavity, the mucosa regenerates naturally with regard to suppleness and surface characteristics; and 3) vascularized myofascial coverage of tissues or materials is useful in some clinical situations. The purpose of this retrospective study was to evaluate the usefulness of this graft material.
Using myofascial flaps from the pectoralis major muscle in 15 patients and from the platysma muscle in 11 patients, several types of reconstructive procedures were conducted in the Department of Oral and Maxillofacial Surgery, Wakayama Medical University.
Myofascial tissue was used to cover the surgical defect and for regeneration of oral mucosa (24 patients), to prevent exposure of the mandibular reconstruction plate (4 patients), for prevention of wound breakdown and secondary infection in the oral cavity (2 patients), for vascularized coverage of free grafted autologous bone (2 patients), and for protection of large vessels after radical neck dissection (9 patients). Although partial flap necrosis or wound dehiscence was noticed in 3 patients with a platysma-myofascial graft, the healing process of all patients was favorable and required no additional operations. This procedure is most suitable for the reconstruction of small to medium-sized soft tissue defects in the oral cavity, because it induces the formation of nearly normal mucosa through epithelial regeneration without clear scar formation.
Myofascial flap is a useful option in certain oral and maxillofacial reconstruction cases in which mucosal regeneration and/or vascularized soft tissue coverage are required.
在当代口腔颌面重建中应考虑使用带蒂肌筋膜移植，原因如下：1) 带蒂肌筋膜单元可靠且易于操作；2) 在口腔内移植的肌筋膜上，黏膜在柔韧性和表面特征方面可自然再生；3) 组织或材料的血管化肌筋膜覆盖在某些临床情况下很有用。本回顾性研究的目的是评估这种移植材料的实用性。
在和歌山医科大学口腔颌面外科，对15例患者使用胸大肌肌筋膜瓣，对11例患者使用颈阔肌肌筋膜瓣，进行了几种类型的重建手术。
肌筋膜组织用于覆盖手术缺损和促进口腔黏膜再生（24例患者）、防止下颌重建钢板外露（4例患者）、预防口腔伤口裂开和继发感染（2例患者）、对游离移植的自体骨进行血管化覆盖（2例患者）以及在根治性颈清扫术后保护大血管（9例患者）。尽管3例使用颈阔肌 - 肌筋膜移植的患者出现了部分皮瓣坏死或伤口裂开，但所有患者的愈合过程良好，无需额外手术。该手术最适合口腔中小尺寸软组织缺损的重建，因为它通过上皮再生诱导形成近乎正常的黏膜，且无明显瘢痕形成。
在某些需要黏膜再生和/或血管化软组织覆盖的口腔颌面重建病例中，肌筋膜瓣是一种有用的选择。
