Dorafshar Amir H, Mundinger Gerhard S, Robinson Brent, Tuffaha Sami, Brandacher Gerald, Byrne Patrick, Walton Robert L
Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Maryland.
Division of Plastic Surgery, Saint Joseph Hospital, Chicago, Illinois.
J Reconstr Microsurg. 2017 May;33(4):244-251. doi: 10.1055/s-0036-1597693. Epub 2016 Dec 26.
The science and technical acumen in the field of vascularized composite allotransplantation has progressed rapidly over the past 15 years, and transplantation of specialized units of the face, such as the nose, appears possible. No study to date has evaluated the technical feasibility of isolated nasal unit transplantation (NUT). In this study, we explore the anatomy and technical specifics of NUT. In this study, four fresh cadaver heads were studied. Bilateral vascular pedicle dissections were performed in each cadaver. The facial artery was cannulated and injected with food dye under physiologic pressure in two cadavers, and with lead oxide mixture in two cadavers to evaluate perfusion territories supplied by each vascular pedicle. The facial artery and vein were found to be adequate pedicles for NUT. Divergent courses of the vein and artery were consistently identified, which made for a bulky pedicle with necessary inclusion of large amounts of subcutaneous tissue. In all cases, the artery remained superficial, while the vein coursed in a deeper plane, and demonstrated consistent anastomoses with the superior transverse orbital arcade. While zinc oxide injection of the facial artery demonstrated filling of the nasal vasculature across the midline, dye perfusion studies suggested that unilateral arterial inflow may be insufficient to perfuse contralateral NUT components. Discrepancies in these two studies underscore the limitations of nondynamic assessment of nutritive perfusion. NUT based on the facial artery and facial vein is technically feasible. Angiosome evaluation suggests that bilateral pedicle anastomoses may be required to ensure optimal perfusion.
在过去15年里，血管化复合组织移植领域的科学技术水平发展迅速，面部特定部位（如鼻子）的移植似乎成为可能。迄今为止，尚无研究评估孤立鼻单位移植（NUT）的技术可行性。在本研究中，我们探究了NUT的解剖结构和技术细节。
在本研究中，对4个新鲜尸头进行了研究。在每个尸头上进行双侧血管蒂解剖。在2个尸头上，将面部动脉插管并在生理压力下注入食用染料，在另外2个尸头上注入氧化铅混合物，以评估每个血管蒂所供应的灌注区域。
发现面部动脉和静脉是NUT的合适血管蒂。一致观察到静脉和动脉走行不同，这使得血管蒂粗大，需要包含大量皮下组织。在所有病例中，动脉均位于浅表，而静脉走行于更深层面，并与眶上横弓有恒定的吻合。虽然对面部动脉注射氧化锌显示鼻血管系统在中线处充盈，但染料灌注研究表明单侧动脉流入可能不足以灌注对侧NUT成分。这两项研究结果的差异突显了营养灌注非动态评估的局限性。
基于面部动脉和面部静脉的NUT在技术上是可行的。血管体评估表明可能需要双侧血管蒂吻合以确保最佳灌注。
