PDF(Pubmed)
Abstract：
(1) Background: The current landscape of midface reconstruction is marked by ongoing evolution, with notable advancements in surgical techniques, microvascular procedures, and the implementation of multidisciplinary approaches, all of which have significantly enhanced both functional and aesthetic outcomes. Conventionally, microvascular anastomoses for free flaps in midfacial reconstruction have been executed using cervical vessels. However, this approach necessitates neck access, resulting in extraoral scars and a substantial pedicle length. In light of these considerations, using intraoral anastomoses via the facial vessels emerges as a promising alternative. This retrospective multicentric study aims to provide a comprehensive account of immediate midface reconstruction through intraoral anastomoses. (2) Methods: Between 2020 and 2023, patients were included who underwent intraoral resection of midface/orbit segments (Brown Classes I-VI) as a result of malignant diseases. In all cases, immediate reconstruction was accomplished by utilizing the facial vessels through an intraoral approach. Outcome criteria were identification of vessels, parotid duct or facial nerve damage, success of vascular anastomoses, and flap survival. (3) Results: A total of 117 patients with 132 flaps (91 osseous and 41 cutaneous) were included. The intraoral preparation of facial vessels was successfully completed in less than 1 h, and no complications related to the dissection or anastomoses were observed. In two cases, the vessel diameter was insufficient to facilitate anastomoses, necessitating adopting an extraoral approach. During a follow-up period of 48 months, two osseous flaps were lost, accounting for a 1.5% loss rate out of 132 flaps used. Additionally, 3 flaps experienced partial loss, including a skin island of a scapula, the border zone of a femur, and a rectus flap, resulting in a 2.3% partial loss rate out of 130 flaps utilized. (4) Conclusions: This case series underscores the feasibility of employing intraoral anastomoses for immediate complex midface reconstruction following oncological resection. This approach is particularly advantageous for flaps with shorter pedicles, as it helps mitigate external scarring and minimizes the risk of facial nerve injury.
摘要：
(1)背景:当前中面重建景观的特点是不断演变,随着外科技术的显著进步，微血管手术，以及多学科方法的实施，所有这些都显著增强了功能和美学效果。传统上,已经使用宫颈血管进行了面部中部重建中游离皮瓣的微血管吻合。然而,这种方法需要进入颈部，导致口外疤痕和大量椎弓根长度。鉴于这些考虑，通过面部血管使用口内吻合成为一种有希望的替代方法。这项回顾性多中心研究旨在全面介绍通过口内吻合立即进行的中面重建。（2）方法：在2020年至2023年之间，由于恶性疾病而接受了中面/眼眶段（棕色I-VI类）口内切除术的患者。在所有情况下,立即重建是通过口内途径利用面部血管完成的。结果标准是识别船只，腮腺导管或面神经损伤，血管吻合的成功，皮瓣存活。（3）结果：共纳入117例患者，皮瓣132例（骨91例，皮41例）。面部血管的口腔内准备在不到1小时内成功完成，未观察到与解剖或吻合相关的并发症。在两种情况下，血管直径不足以促进吻合，有必要采取一种非常规的方法。在48个月的随访期间，失去了两个骨瓣,在使用的132个襟翼中，损失率为1.5%。此外,3个皮瓣经历了部分损失，包括肩胛骨的皮肤岛，股骨的边界区域，和一个直肌皮瓣,在130个襟翼中，部分损失率为2.3%。（4）结论：该病例系列强调了在肿瘤切除后采用口内吻合进行立即复杂的中面重建的可行性。这种方法对于椎弓根较短的皮瓣特别有利，因为它有助于减轻外部疤痕，并最大限度地减少面神经损伤的风险。
