Patel Parit A, Chen Wendy, Wilkening Matthew W, Uribe-Rivera Armando, Racadio John M, Gordon Christopher B
Institute of Reconstructive Plastic Surgery, New York University Langone Medical Center, New York, USA.
J Craniofac Surg. 2013 Jan;24(1):273-7. doi: 10.1097/SCS.0b013e318270fc23.
The authors have expanded upon a well-described and widely used flap in the head and neck region. The purpose of the cadaver study was to determine the feasibility, angiosome, and the potential application of this pedicled flap in bone tissue engineering of the mandible.
A total of 6 fresh human cadaver heads were dissected for a total of 12 flaps. The extended composite temporoparietal fascial flap, based on the superficial temporal artery (STA) and including cranial periosteum, was dissected and the dimensions were measured. Through a combined submandibular and preauricular incision, the mandible was exposed and the dimensions were measured from the sigmoid notch to the gonion angle and from the gonion angle to the symphysis. CT angiography and silicone injections were performed to identify the vascular anatomy of the flap.
The combined distance from the sigmoid notch to the gonion and the gonion to the symphysis, plotted versus the cranial apex to tragus length, demonstrated adequate flap dimensions in all specimens for hemi-mandibular reconstruction. The average flap length was 16.5 ± 1.40 cm and the average flap width was 11.4 ± 0.98 cm, resulting in an average flap surface area of 94.5 ± 13.08 cm. Radiographic images and silicone injections confirmed STA perfusion of the cranial periosteum.
The extended composite temporoparietal fascial flap with periosteum can be a viable option for providing vascularized periosteum in tissue-engineered craniofacial reconstruction.
作者对头部和颈部区域一种描述详尽且广泛应用的皮瓣进行了拓展。尸体研究的目的是确定这种带蒂皮瓣在下颌骨组织工程中的可行性、血管体以及潜在应用。
共解剖6个新鲜人类尸体头部，获取12个皮瓣。解剖基于颞浅动脉（STA）并包含颅骨骨膜的扩展复合颞顶筋膜皮瓣，测量其尺寸。通过下颌下和耳前联合切口暴露下颌骨，测量从乙状切迹到下颌角以及从下颌角到耻骨联合的尺寸。进行CT血管造影和硅胶注射以确定皮瓣的血管解剖结构。
将从乙状切迹到下颌角以及从下颌角到耻骨联合的总距离与颅顶到耳屏长度作图，结果表明在所有标本中皮瓣尺寸足以进行半侧下颌骨重建。皮瓣平均长度为16.5±1.40厘米，平均宽度为11.4±0.98厘米，皮瓣平均表面积为94.5±13.08平方厘米。影像学图像和硅胶注射证实了颞浅动脉对颅骨骨膜的灌注。
带骨膜的扩展复合颞顶筋膜皮瓣可为组织工程化颅面重建提供带血管蒂的骨膜，是一种可行的选择。
