游离背阔肌肌瓣联合自体脂肪填充序列治疗修复半侧颜面萎缩(1)
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[摘要]目的：探讨游离背阔肌肌瓣联合自体脂肪填充序列治疗修复半侧颜面萎缩的效果。方法：对9例半侧颜面萎缩患者，采用I期行游离背阔肌肌瓣移植，于术后0.5～1年行II期自体脂肪填充术。根据面部对称情况行1～3次自体脂肪填充，观察其临床效果。结果：9例肌瓣全部成活，术后0.5～1年观察肌瓣轻度下垂，可见局限性凹陷。经1-3次自体脂肪填充后面部外观明显改善，对称性良好，供区无明显功能障碍。结论：游离背阔肌肌瓣联合自体脂肪填充序列治疗是矫治中、重度半侧颜面萎缩的较好选择，结合不同手术特点的综合治疗，能够显著提高中、重度半侧颜面萎缩的治疗效果。
[关键词]背阔肌肌瓣；自体脂肪；半侧颜面萎缩
[中图分类号]R622 [文献标识码]A [文章编号]1008-6455(2012)05-0705-03
Reconstruction of hemifacial atrophy using free latissimus dorsi muscular flap and injected autologous fat transplantation
TANG Hong-bo,CHEN Xue,ZHOU Fang,FENG You-ping
(Department of Plastic Surgery, Tongji Hospital,Tongji Medical College,Huzhong University of Science and Technology,Wuhan 430030, Hubei,China)
Abstract: Objective To investigate the effect of free latissimus domi muscular flap and injected autologous fat transplantation in reconstruction of hemifacial atrophy. Methods 9 patients with hemifacial atrophy were treated with free latissimus domi muscular flap at first stage. Then injected autologous fat transplantation was applied in the second stage after 6 to 12 months. Once to three times atuologous fat filling was applied according to the operation effect, and the clinic effects were observed. Results 9 flaps survived completely. Mild ptosis of muscular flap was observed after 6 to 12 months. Local depression was visible either. Facial appearance was improved obviously after one to three times of autologous fat transplantation. No obvious dysfunction was showed in donor site. Conclusion Combined application of free latissimus domi muscular flap and injected autologous fat transplantation is the best option for moderate and severe hemifacial atrophy. Comprehensive therapy combined with characteristics of the different operations can improve the treatment efficacy on moderate and severe hemifacial atrophy.
Key words:latissimus muscular flap;autologous fat;hemifacial atrophy
半侧颜面萎缩，又称Parry-Romberg综合征，是一种病程进展缓慢，以一侧面部皮肤、皮下组织甚至肌肉、骨骼的进行性萎缩为特征的疾病。该病高发年龄10～20岁，女性发病率为男性的1.5倍，病情经过数年的活跃进展期后进入稳定期[1]。该病对患者的外观、功能及心理都具有严重的影响。吻合血管的组织瓣游离移植及自体脂肪填充是本病治疗的标准术式，但两种方法各有优劣。吻合血管的组织瓣游离移植提供组织量大，容易塑形，但可能出现下垂、萎缩；自体脂肪组织注射填充具有不切开、手术时间短、操作简便等优点，但吸收较明显、需多次注射、还可能并发感染。笔者结合以上特点，联合应用两种方法，于2005年～2010年采用先行游离背阔肌肌瓣移植，后期自体脂肪注射填充的序列治疗方案治疗半侧颜面萎缩9例，取得良好效果，现报道如下。
1 资料和方法 ......
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