摘要目的 介绍一种基于美容单位的自由式穿支皮瓣在面部肿瘤切除后缺损修复中的应用.方法 2013年12月至2017年1月苏州大学附属第二医院整形美容科收治72例面部肿瘤切除后缺损患者,男31例,女41例,年龄45～101岁.依据术前多普勒血流探测仪对创面周围穿支血管的探测信号,结合面部美容单位,不拘泥于传统的面部解剖学标志及解剖变异限制,更“自由”地设计以穿支血管为蒂的V-Y推进皮瓣、旋转皮瓣、螺旋桨皮瓣等多种形式皮瓣,修复创面.皮瓣最大面积12.0 cm×6.0 cm,最小面积1.5 cm ×1.0cm,蒂部穿支血管直径0.3～3.0 mm,部分蒂部为穿支血管束.结果 本组72例,68例一期愈合,术后外形良好;1例术后出血,皮瓣张力较大,切口愈合不良,予换药处理,2周后愈合;3例静脉回流不畅,皮瓣淤血,针刺放血处理后,延迟愈合.结论 对于肿瘤扩大切除后面部缺损的修复,基于面部美容单位及术前多普勒探查的穿支血管设计自由式穿支皮瓣,是一种安全、可靠、多形的皮瓣,既可在皮瓣的选择方面提供更大的自由度,又可取得更好的美容效果.

abstractsObjective To introduce the application of free-style perforator flap based on aesthetic units to repair facial defect after tumor resection.Methods By following the concept of free-style perforator flap and the principle of facial aesthetic unit,the design of a free-style perforator flap allowed over any nearby cutaneous vessel chosen purely on the characteristics of its Doppler signal.Conventional knowledge of anatomical landmarks and possible vascular variations were less relevant.A greater freedom in flap selection was gained to recover defect in different forms such as rotation flap,advanced flap and propeller flap,which were all based on free-style perforators.The flap size ranged from 1.5 cm×1.0 cm to 12.0 cm× 6.0 cm with the perforator diameter of 0.3-3.0 mm in pedicle,and some of the pedicles are " perforator clusters".Results A total of 72 cases underwent surgery,and 68 cases survived completely with satisfactory appearance.1 case healed two weeks later through dressing due to undesired healing,which result ed from high tension secondary postoperative blooding.3 cases healed in a delay due to congestion and gained acupuncture treat.Conclusions The free-style perforator flap,which depended on Dopplerdiscerned perforator and facial aesthetic unit,represents safe,reliable and versatile for repairing facial defect after extended resection,and it not only offers a greater freedom in flap selection but also provides good aesthetic result.