Department of Plastic and Reconstructive Surgery, First Medical Center of Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China.
College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China.
Microsurgery. 2023 Jul;43(5):476-482. doi: 10.1002/micr.30996. Epub 2022 Dec 18.
The reconstruction of large fistulous defects following the radical ablation of maxillary sinus carcinoma remains challenging. The procedure requires not only the coverage of both intra-nasal lining and cheek skin but also sufficient obliteration of dead space between the two surfaces. In this report, we present our experience on the reconstruction of through-and-through defects in the mid-face with poly-foliated chimeric perforator flaps.
Nine patients (five males and four females) who received a two-skin paddled and one muscle segment chimeric perforator flap reconstruction after maxillary sinus carcinoma ablation between March 2015 and December 2019 were retrospectively reviewed in authors' hospital. The mean age of the patients was 59.11. Six patients were diagnosed as squamous cell carcinoma, two as adenoid cystic carcinoma, and one as adenocarcinoma. Brown class IIIa defects were found in eight patients, and one patient had a Brown class IVa defect. The mean size of intra-nasal defect was 5.67 × 4.06 cm , and the mean size of facial skin defect was 8.94 × 6.56 cm . ALT flaps were used in five patients, LD flaps in four patients. The minor skin paddle was firstly inset to the mucosal defect site as the lining. Then, the muscle segment was inset to eliminate the dead cavity. Finally, the major skin paddle was inset to recover the cutaneous defect.
In ALT group, the mean size of the minor skin paddle was 5.7 × 4.7 cm , and the mean size of the major skin paddle was 8.7 × 6.6 cm . In LD group, the mean size of the minor skin paddle was 6.88 × 4.38 cm , and the mean size of the major skin paddle was 11 × 7.75 cm .All donor sites were closed primarily. All flaps survived and no partial flap loss was encountered. The mean follow-up time was 14.67 months, and there were no major postoperative complications.
The use of poly-foliated chimeric perforator free flaps can provide functional and aesthetic coverage for extensive through-and-through mid-face defects without significant donor-site morbidities.
上颌窦癌根治性切除术后的大面积瘘管缺损的重建仍然具有挑战性。该手术不仅需要覆盖鼻腔内衬和脸颊皮肤，还需要充分填塞两个表面之间的死腔。在本报告中，我们介绍了使用多叶嵌合穿支皮瓣重建中面部贯穿性缺损的经验。
作者医院回顾性分析了 2015 年 3 月至 2019 年 12 月期间接受上颌窦癌切除术后双皮瓣加一肌段嵌合穿支皮瓣重建的 9 例（男 5 例，女 4 例）患者。患者平均年龄为 59.11 岁。6 例诊断为鳞状细胞癌，2 例为腺样囊性癌，1 例为腺癌。8 例患者为 Brown Ⅲa 类缺损，1 例患者为 Brown Ⅳa 类缺损。鼻腔内缺损的平均大小为 5.67×4.06cm，面部皮肤缺损的平均大小为 8.94×6.56cm。5 例患者使用 ALT 皮瓣，4 例患者使用 LD 皮瓣。首先将小皮瓣插入黏膜缺损部位作为衬里。然后，将肌段插入以消除死腔。最后，将大皮瓣插入以修复皮肤缺损。
在 ALT 组中，小皮瓣的平均大小为 5.7×4.7cm，大皮瓣的平均大小为 8.7×6.6cm。在 LD 组中，小皮瓣的平均大小为 6.88×4.38cm，大皮瓣的平均大小为 11×7.75cm。所有供区均一期闭合。所有皮瓣均存活，未发生部分皮瓣坏死。平均随访时间为 14.67 个月，无重大术后并发症。
使用多叶嵌合穿支游离皮瓣可为广泛的中面部贯穿性缺损提供功能和美学覆盖，且供区无明显并发症。
