Department of oral and maxillofacial surgery, technical university Munich, Klinikum Rechts der Isar, Ismaninger Street 22, 81675 München, Germany.
J Stomatol Oral Maxillofac Surg. 2017 Sep;118(4):238-241. doi: 10.1016/j.jormas.2017.06.004. Epub 2017 Jun 19.
The scope of microvascular tissue transfer in the Head and Neck reaches from coverage of simple soft tissue defects to complex 3-D reconstructions using multiple or chimeric flaps. This paper summarises the presentation given at the Congress of the French Society of Oral and Maxillofacial Surgery in Marseille 2017. It was the aim of our work to add further elements to this wide spectrum of reconstructive possibilities.
For patients with small intraoral soft tissue defects in whom the use of a radial forearm flap would not be justified because of its donor site morbidity, but who nevertheless would take a benefit from a small free flap, we used mini-perforator flaps from the lower leg. These flaps were raised with negligible morbidity. Moreover, for patients necessarily needing a free flap, but having vessel depleted, irradiated necks, we have developed a first idea of extracorporeal flap perfusion to make microvascular anastomoses unnecessary.
Using donor sites from the lower leg, mini-soleus and medial sural perforator flaps were raised to cover defects of 2×3 to 2×4cm at the anterior floor of the mouth or lateral tongue. The success rate was 91%, and despite their small size, the flaps helped to maintain the mobility of the tongue. The donor site morbidity was minimal. After extensive experimental work on small animals and human tissue, four flaps could successfully be transferred so far by means of extracorporeal perfusion. In these patients, autonomisation took place between 5 and 12 days.
Although microvascular tissue transfer already allows for reconstruction in almost any possible defect constellation, mini-perforator flaps and machine-perfused transplants seem to represent new aspects of free flap surgery, being useful extensions of the reconstructive surgeon's armament.
头颈部的微血管组织转移范围从简单软组织缺损的覆盖到使用多个或嵌合皮瓣进行复杂的 3D 重建。本文总结了 2017 年在马赛举行的法国口腔颌面外科学会大会上的演讲内容。我们的工作旨在为这一广泛的重建可能性增加更多元素。
对于那些口腔内小的软组织缺损的患者，如果使用前臂皮瓣由于供区的发病率而不适合，但他们仍然可以从小的游离皮瓣中获益，我们使用小腿的迷你穿支皮瓣。这些皮瓣的提起具有可忽略的发病率。此外，对于那些需要游离皮瓣但颈部血管耗竭、接受过放疗的患者，我们提出了体外皮瓣灌注的初步设想，以使微血管吻合术变得不必要。
使用小腿、迷你比目鱼肌和内侧腓肠肌穿支皮瓣作为供区，用于覆盖口底前壁或侧舌 2×3 至 2×4cm 的缺损。成功率为 91%，尽管皮瓣较小，但有助于保持舌头的活动性。供区发病率很低。在对小动物和人体组织进行了广泛的实验工作后，迄今为止已经成功地通过体外灌注转移了四例皮瓣。在这些患者中，自主化发生在 5 至 12 天之间。
尽管微血管组织转移已经可以在几乎任何可能的缺损情况下进行重建，但迷你穿支皮瓣和机器灌注移植似乎代表了游离皮瓣手术的新方面，是重建外科医生的武器的有用扩展。
