中国修复重建外科杂志

中国修复重建外科杂志

以旋髂深动脉为蒂的髂骨-腹内斜肌筋膜嵌合瓣修复下颌骨口腔黏膜复合缺损

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目的 探讨以旋髂深动脉为蒂的髂骨-腹内斜肌筋膜嵌合瓣(deep circumflex iliac artery based iliac-internal oblique musculofascial chimeric flap,DCIA-IIOF)修复下颌骨口腔黏膜复合缺损的可行性和疗效。 方法 2010 年 1 月—2015 年 12 月,采用 DCIA-IIOF 修复 11 例下颌骨口腔黏膜复合缺损患者。其中男 8 例,女 3 例;年龄 27~75 岁,中位年龄 56 岁。原发疾病:下牙龈癌 7 例(T3N1M0 2 例、T3N2M0 1 例、T4N0M0 2 例、T4N2M0 2 例),鼻咽癌放疗后下颌骨坏死 2 例,下颌骨中心性鳞癌(T4N0M0)1 例,下颌骨恶性纤维组织细胞瘤 1 例。下颌骨切除后缺损长度 7~10 cm,平均 8 cm;黏膜缺损面积 5 cm×3 cm~7 cm×4 cm。术前彩色超声定位 DCIA 及其升支,顺行解剖血管制备 DCIA-IIOF,其中髂骨瓣修复下颌骨缺损,腹内斜肌及其筋膜修复软组织及黏膜缺损。 结果 11 例患者均获随访,随访时间 15~75 个月,中位时间 37 个月。术后 DCIA-IIOF 全部成活,均无髂骨瓣及腹内斜肌筋膜瓣坏死发生。1 例术后颌下区轻度感染,经引流使用抗生素后痊愈。术后 1 个月口内腹内斜肌筋膜瓣黏膜化明显,颜色质地与口腔黏膜相近,无明显挛缩,上下颌咬合关系良好。术后 6 个月 2 例放疗后下颌骨坏死患者张口改善不明显,接受术后放疗的 4 例中 1 例张口受限,其余患者均无张口受限,进食正常。随访期间 3 例死于肿瘤复发,2 例死于其他疾病(脑出血 1 例、大面积心肌梗死 1 例),余 6 例均无瘤生存;均无腹壁疝发生。 结论 DCIA-IIOF 修复下颌骨口腔黏膜复合缺损安全可靠,术后上下颌咬合关系良好,创面质地柔软,是中型下颌骨口腔黏膜复合缺损修复方法之一。

Objective To evaluate the reliability and effectiveness of a deep circumflex iliac artery based iliac-internal oblique musculofascial chimeric flap (DCIA-IIOF) in reconstruction of complex oromandibular defect. Methods Between January 2010 and December 2015, DCIA-IIOFs were used to repair complex oromandibular defects in 11 patients. There were 8 males and 3 females, with an age of 27-75 years (median, 56 years). Original disease was lower gingival squamous cell carcinoma in 7 cases (T3N1M0 in 2 cases, T3N2M0 in 1 case, T4N0M0 in 2 cases, and T4N2M0 in 2 cases), osteoradionecrosis after radiotherapy for nasopharyngeal carcinoma in 2 cases, central mandibular squamous cell carcinoma in 1 case (T4N0M0), and mandibular malignant fibrous histiocytoma in 1 case. The length of mandibular bone defects ranged from 7 to 10 cm (mean, 8 cm), and the area of the mucosal defects ranged from 5 cm×3 cm to 7 cm×4 cm. Preoperative ultrasonic identification of the DCIA and its ascending branch was routinely performed. The DCIA-IIOF was harvested by using an anterograde dissection technique, of which the iliac island was used for segmental mandibular defect repair and the musculofascial island for soft tissue and mucosal defect repair. Results All 11 cases were followed up 15-75 months (median, 37 months). All flaps survived after operation, without necrosis of both iliac island and oblique internal musculofascial island. One patient had a mild submandibular infection which healed after wound drainage and intravenous antibiotics. At 1 month after operation, the color and texture of the musculofascial island were similar to oral mucosa without contracture, and the occluding relation was good for all patients. At 6 months after operation, the mouth opening hardly improved in 2 patients who had osteoradionecrosis; 1 patient who underwent postoperative radiotherapy had restriction of mouth opening; the remaining 8 patients had normal month opening and normal diet. Three patients died of cancer recurrence, 2 patients died of other diseases (encephalorrhagia in 1 case and myocardial infarction in 1 case), and the others survived without recurrence during follow-up. No patient developed abdominal hernia during follow-up. Conclusion DCIA-IIOF is a reliable flap in reconstruction of complex oromandibular defects. The occluding relation after operation is good and the mucosal lining is soft. This technique provides an effective option for moderate complex oromandibular defects repair.

关键词: 下颌骨; 旋髂深动脉; 髂骨-腹内斜肌筋膜嵌合瓣; 口腔肿瘤

Key words: Mandible; deep circumflex iliac artery; iliac-internal oblique musculofascial chimeric flap; oral neoplasm

引用本文: 彭汉伟, 林建英, 郭海鹏, 刘木元. 以旋髂深动脉为蒂的髂骨-腹内斜肌筋膜嵌合瓣修复下颌骨口腔黏膜复合缺损. 中国修复重建外科杂志, 2018, 32(12): 1567-1571. doi: 10.7507/1002-1892.201806023 复制

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