얼굴이식을 위한 운동과 감각신경을 가진 중하안면피판 모델 (파노라마 얼굴피판)에 대한 연구 = A New Facial Composite Flap Model(Panorama Facial Flap) with Sensory and Motor Nerve from Cadaver Study for Facial Transplantation

다국어 초록 (Multilingual Abstract)

A New Facial Composite Flap Model(Panorama Facial Flap) with Sensory and Motor Nerve from Cadaver Study for Facial Transplantation Peter Chan Woo Kim, M.D.1, Eon Rok Do, M.D.1, Hong-Tae Kim, M.D.21Department of Plastic and Reconstructive Surgery, Daegu Catholic University Medical Center,2Department of Anatomy, School of Medicine, Daegu Catholic University, Daegu, Korea

Purpose: The purpose of this study was to investigate the possibility that a dynamic facial composite flap with sensory and motor nerves could be made available from donor facial composite tissue.
Methods: The faces of 3 human cadavers were dissected. The authors studied the donor faces to assess which facial composite model would be most practicable. A "panorama facial flap" was excised from each facial skeleton with circumferential incision of the oral mucosa, lower conjunctiva and endonasal mucosa. In addition, the authors measured the available length of the arterial and venous pedicles, and the sensory nerves. In the recipient, the authors evaluated the time required to anastomose the vessels and nerve coaptations, anchor stitches for donor flaps, and skin stitches for closure.
Results: In the panorama facial flap, the available anastomosing vessels were the facial artery and vein. The sensory nerves that required anastomoses were the infraorbital nerve and inferior alveolar nerve. The motor nerve requiring anstomoses was the facial nerve. The vascular pedicle of the panorama facial flap is the facial artery and vein. The longest length was 78mm and 48mm respectively. Sensation of the donor facial composite is supplied by the infraorbital nerve and inferior alveolar nerve. Motion of the facial composite is supplied by the facial nerve. Some branches of the facial nerve can be anastomosed, if necessary.
Conclusion: The most practical facial composite flap would be a mid and lower face flap, and we proposed a panorama facial flap that is designed to incorporate the mid and lower facial skin with and the unique tissue of the lip. The panorama facial composite flap could be considered as one of the practicable basic models for facial allotransplantation.
(J Korean Cleft Palate Craniofac Assoc 12: 86, 2011)

참고문헌 (Reference)

• 1 Pomahac B, "Vascular considerations in composite midfacial allotransplantation" 125 (125): 2010
• 2 Meningaud JP, "The Procurement of allotransplants for ballistic trauma: a preclinical study and a report of two clinical cases" 127 (127): 2011
• 3 Meningaud JP, "Procurement of total human face graft for allotransplantation: a preclinical study and the first clinical case" 126 (126): 2010
• 4 Siemionow MZ, "First U.S. near-total human face transplantation: a paradigm shift for massive complex injuries" 125 (125): 2010
• 5 Meningaud JP, "Face transplant graft procurement: a preclinical and clinical study" 122 (122): 2008
• 6 Devauchelle B, "Dubernard JM: First human face allograft: early report" 368 (368): 2006
• 7 Wang HY, "Cadaveric comparison of two facial flap-harvesting techniques for alloplastic facial transplantation" 60 (60): 2007
• 8 Siemionow M, "A cadaver study in preparation for facial allograft transplantation in humans: Part II. Mock facial transplantation" 117 (117): 2006
• 9 Siemionow M, "A cadaver study in preparation for facial allograft transplantation in humans: Part I. What are alternative sources for total facial defect coverage" 117 (117): 2006