Germain M A, Demers G, Parent F, Luboinski B, Hureau J
Service de Chirurgie, Hôpital Max-Fourestier, Nanterre.
Chirurgie. 1993;119(5):263-7.
The aim of prefabricated free transplants is to create a composite graft including a vascular pedicle with artery and vein, a muscle and its nerve, cellular tissue, bony tissue, cartilage, periosteum, and skin with its sensory nerve. This composite transplant is entirely constructed and modelled around the chosen vascular pedicle beforehand. Once the various materials of the future graft are removed and put in contact with the vascular pedicle, the subsequent neovascularisation should nourish the different elements. The vasculonervous pedicle, with the graft, are transplanted five weeks after preconstruction, revascularized and reinnervated. With these free prefabricated transplants, graft tissue which does not exist in the organism can be created. Cosmetic sequellae can be avoided since the vascular pedicle is chosen beforehand. Ear-nose-throat and plastic surgeons have used local structural preconstruction for many years, especially for ear reconstruction. The work presented here has the original feature of revascularized free transplant. From 1988, we have performed two complete reconstructions of the nose using a free forearm transplant modelled into a nasal pyramid. The classical techniques could not be used. In the first case a radius strut was used to form the nasal crest. In the second a chondrocostal cartilage was used. Transplantation was performed five weeks after preconstruction. In both cases, transplant viability was excellent but the cosmetic and functional results were less than satisfactory and required reoperation.
预制游离移植的目的是创建一个复合移植物，包括带有动静脉的血管蒂、肌肉及其神经、细胞组织、骨组织、软骨、骨膜以及带有感觉神经的皮肤。这个复合移植物完全是预先围绕所选的血管蒂构建和塑形的。一旦将未来移植物的各种材料取出并与血管蒂接触，随后的新生血管化过程应滋养不同的组织成分。血管神经蒂与移植物在预制五周后进行移植，实现血管再通和神经再支配。通过这些游离预制移植，可以创建机体中原本不存在的移植组织。由于预先选择了血管蒂，因此可以避免美容后遗症。耳鼻喉科和整形外科医生多年来一直使用局部结构预制技术，尤其是用于耳部重建。这里介绍的工作具有血管化游离移植的独特之处。自1988年以来，我们使用塑形为鼻锥体的游离前臂移植进行了两次全鼻重建。无法使用传统技术。在第一个病例中，使用桡骨支柱形成鼻嵴。在第二个病例中，使用肋软骨。预制五周后进行移植。在这两个病例中，移植的存活率都很高，但美容和功能效果均不尽人意，需要再次手术。
