Bastidas Nicholas, Runyan Christopher M, Jones Donna C, Taylor Jesse A
Hospital of the University of Pennsylvania , Philadelphia, PA , USA.
J Plast Surg Hand Surg. 2013 Dec;47(6):528-31. doi: 10.3109/2000656X.2013.793194. Epub 2013 May 6.
Conventional reconstructive procedures for face and scalp reconstruction fall short of aesthetic and functional goals because of the unique quality and quantity of facial and scalp soft tissue. The purpose of this cadaver study was to demonstrate the feasibility of a flap design for full face and scalp composite tissue allotransplantation, without cutaneous facial scars. Six fresh human cadavers were dissected with sagittal scalp and mucosal incisions for full face and scalp harvest without cutaneous facial incisions. Sub-galeal and sub-SMAS dissection allowed for inclusion of the external carotid and internal jugular systems. Time of facial-scalp flap harvesting, length of the arterial and venous pedicles, length of sensory nerves (that were included in the facial flaps) and approximate surface area of the flaps were measured. Three of six flaps were transferred to recipient cadavers and the time of transfer was recorded. As a proof of concept, the external carotid arteries of one of six cadavers was flushed to remove clots and perfused with a radio-opaque latex polymer, Microfil (Flow Tech Inc.), to study flap perfusion by X-ray imaging. In the donor cadaver, the mean harvesting time of the total facial-scalp flap was 105 ± 19 minutes. The mean length of the supraorbital, infraorbital, mental and great auricular nerves were 1.3 ± 0.2, 1.3 ± 0.1, 1.3 ± 0.1, and 4.8 ± 0.6 cm, respectively. The mean length of the external carotid artery and external jugular vein were 8.7 ± 0.3 and 9.2 ± 0.4 cm, respectively. The approximate area of the harvested flap was 1063 ± 60 cm(2). In preparation for full face and scalp allotransplantation in humans, this study has demonstrated the feasibility of a full face and scalp flap without visible facial incisions.
由于面部和头皮软组织的独特性质和数量，用于面部和头皮重建的传统重建手术无法达到美学和功能目标。本尸体研究的目的是证明一种无面部皮肤瘢痕的全脸和头皮复合组织同种异体移植皮瓣设计的可行性。对6具新鲜人体尸体进行解剖，采用矢状头皮和黏膜切口，在不做面部皮肤切口的情况下获取全脸和头皮。帽状腱膜下和SMAS下解剖可保留颈外动脉和颈内静脉系统。测量面部 - 头皮皮瓣的获取时间、动静脉蒂长度、（包含在面部皮瓣中的）感觉神经长度以及皮瓣的大致表面积。6个皮瓣中的3个转移至受体尸体，并记录转移时间。作为概念验证，对6具尸体中的1具的颈外动脉进行冲洗以清除血栓，并用不透射线的乳胶聚合物Microfil（Flow Tech Inc.）进行灌注，通过X射线成像研究皮瓣灌注情况。在供体尸体中，全脸 - 头皮皮瓣的平均获取时间为105±19分钟。眶上神经、眶下神经、颏神经和耳大神经的平均长度分别为1.3±0.2、1.3±0.1、1.3±0.1和4.8±0.6厘米。颈外动脉和颈外静脉的平均长度分别为8.7±0.3和9.2±0.4厘米。获取的皮瓣大致面积为1063±60平方厘米。在为人类全脸和头皮同种异体移植做准备时，本研究证明了一种无可见面部切口的全脸和头皮皮瓣的可行性。
