中国修复重建外科杂志

中国修复重建外科杂志

CT 血管造影辅助设计股前外侧(肌)皮瓣修复口腔颌面部软组织缺损

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目的 探讨应用 CT 血管造影(computed tomography angiography,CTA)辅助设计股前外侧(肌)皮瓣修复口腔颌面部软组织缺损的临床效果。 方法 2011 年 1 月—2015 年 12 月,收治 23 例口腔颌面部肿瘤患者。男 14 例,女 9 例;年龄 45~72 岁,平均 56.8 岁。舌癌 12 例,口颊癌 5 例,口底癌 4 例,口咽癌 2 例;均为鳞状细胞癌。按国际抗癌联盟(UICC)标准 TNM 分期:T 2N 0M 08 例,T 2N 1M 0 3 例,T 2N 2M 0 1 例,T 3N 0M 0 4 例,T 3N 1M 0 2 例,T 3N 2M 0 2 例,T 4N 1M 0 2 例,T 4N 2M 0 1 例。病程 1~6 个月,平均 2.4 个月。术前均行 CTA 检查,定位股前外侧皮瓣穿支血管及其穿出点体表投影点,辅助设计股前外侧(肌)皮瓣。术中扩大切除肿瘤后,遗留软组织缺损范围为 6 cm×4 cm~11 cm×7 cm;并参照术前设计切取皮瓣修复缺损,其中股前外侧薄型皮瓣 14 例,股前外侧肌皮瓣 7 例,股前外侧双叶瓣 2 例;皮瓣切取范围为 7 cm×5 cm~12 cm×8 cm。供区直接拉拢缝合。 结果 经术前 CTA 检查,22 例明确定位穿支血管穿出股前外侧阔筋膜位置,穿支血管定位率为 95.7%(22/23)。1 例术后第 5 天出现颌下漏口,经换药后愈合;其余供区及受区切口均Ⅰ期愈合。1 例皮瓣因静脉回流不畅,改为吻合 2 根静脉,皮瓣顺利成活;其余皮瓣均顺利成活。术后患者均获随访,随访时间 6~36 个月,平均 16.4 个月。术后 3 个月,参照华盛顿大学生存质量量表(UW-QOL),制定简化言语功能恢复标准及吞咽功能恢复标准,22 例言语及吞咽功能恢复达满意,1 例右口底高分化鳞状细胞癌(T 4N 1M 0)言语及吞咽功能达较满意。23 例术后受区未见明显组织萎缩,供区未出现运动感觉功能障碍。随访期间,21 例未见肿瘤复发及转移,1 例术后 6 个月出现对侧颈淋巴结转移再次手术,术后生存 23 个月后死亡;1 例术后 10 个月出现远处转移死亡。 结论 通过 CTA 辅助设计股前外侧(肌)皮瓣,修复口腔颌面部软组织缺损后受区形态及功能恢复理想。

Objective To investigate the efficacy of anterolateral thigh (myocutaneous) flap designed with computed tomography angiography (CTA) to reconstruct oral and maxillofacial soft tissue defects. Methods Between January 2011 and December 2015, 23 cases of oral and maxillofacial tumors were treated. There were 14 males and 9 females with the age range from 45 to 72 years (mean, 56.8 years). There were 12 cases of tongue carcinoma, 5 cases of buccal mucosa carcinoma, 4 cases of mouth floor carcinoma, and 2 cases of oropharynx carcinoma; all were squamous cell carcinoma. According to standard TNM staging of the Union for International Cancer Control (UICC), 8 cases were rated as T 2N 0M 0, 3 cases as T 2N 1M 0, 1 case as T 2N 2M 0, 4 cases as T 3N 0M 0, 2 cases as T 3N 1M 0, 2 cases as T 3N 2M 0, 2 cases as T 4N 1M 0, and 1 case as T 4N 2M 0. The course of disease was 1-6 months (mean, 2.4 months). CTA was performed before operation to locate the perforator vessel and its surface projection of emerging point and to design anterolateral thigh (myocutaneous) flap by computer. The defects of soft tissue ranged from 6 cm×4 cm to 11 cm×7 cm after resection of tumor. The flap was used to repair defects, including 14 thinned anterolateral thigh flaps, 7 anterolateral thigh myocutaneous flaps, and 2 anterolateral bilobed flaps; and the flap area ranged from 7 cm× 5 cm to 12 cm×8 cm. The donor sites were sutured directly. Results CTA showed that myocutaneous perforators penetrated at the fascias of the vastus lateralis muscles in 22 cases with a location rate of 95.7% (22/23). Submandibular fistula occurred in 1 case at 5 days after operation and fistula healed after changed dressings. Other wounds at recipient site and donor site healed at primary stage. Anastomose with 2 vein was performed because of poor venous return in 1 case, and the flap survived. The other flaps survived well. All the patients were followed up 6-36 months (mean, 16.4 months). At 3 months after operation, the simplified recovery standard of speech function and swallow function was established according to the University of Washington Quality of Life Scale (UW-QOL). The speech and swallow function recovered satisfactorily in 22 cases, and not very satisfactorily in 1 case of well differentiated squamous cell carcinoma of the right mouth floor (T 4N 1M 0). No obvious tissue atrophy was observed in 23 cases. No dysfunction was found at the donor site. There was no tumor recurrence in 21 patients; 1 patient accepted the second operation due to lymphonodi metastasis of contralateral neck at 6 months after first operation, who died after 23 months; 1 patient died of distant metastasis at 10 months after first operation. Conclusion The anterolateral thigh (myocutaneous) flap designed with CTA could well recover the morphology and function of the recipient site.

关键词: CT 血管造影; 股前外侧(肌)皮瓣; 口腔颌面部; 创面修复

Key words: Computed tomography angiography; anterolateral thigh (myocutaneous) flap; oral and maxillofacial region; wound repair

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1. Ren ZH, Wu HJ, Tan HY, et al. Transfer of anterolateral thigh flaps in elderly oral cancer patients: complications in oral and maxillofacial reconstruction. J Oral Maxillofac Surg, 2015, 73(3): 534-540.
2. Agostini T, Russo GL, Zhang YX, et al. Adipofascial anterolateral thigh flap safety: applications and complications. Arch Plast Surg, 2013, 40(2): 91-96.
3. Kim H, Jeong WJ, Ahn SH. Results of free flap reconstruction after ablative surgery in the head and neck. Clin Exp Otorhinolaryngol, 2015, 8(2): 167-173.
4. 邓伟, 黄代营, 王鸿, 等. 游离股前外侧皮瓣修复口腔颌面部软组织缺损. 中华显微外科杂志, 2014, 37(4): 404-405.
5. Lu MX, Sun GW, Hu QG, et al. Functional assessment: Free thin anterolateral thigh flap versus free radial forearm reconstruction for hemiglossectomy defects. Med Oral Patol Oral Cir Bucal, 2015, 20(6): e757-762.
6. Chiu WK, Lin WC, Chen SY, et al. Computed tomography angiography imaging for the chimeric anterolateral thigh flap in reconstruction of full thickness buccal defect. ANZ J Surg, 2011, 81(3): 142-147.
7. Lin CH, Chiu YH, Perng CK, et al. Experience With the Use of Free Fasciocutaneous Flap in Through-and-Through Cheek-Buccal Defect Reconstruction: Surgical Outcome and Quality of Life Analysis. Ann Plast Surg, 2016, 76 Suppl 1: S74-79.
8. Lakhiani C, Lee MR, Saint-Cyr M. Vascular anatomy of the anterolateral thigh flap: a systematic review. Plast Reconstr Surg, 2012, 130(6): 1254-1268.
9. Liu SC, Chiu WK, Chen SY, et al. Comparison of surgical result of anterolateral thigh flap in reconstruction of through-and-through cheek defect with/without CT angiography guidance. J Craniomaxillofac Surg, 2011, 39(8): 633-638.
10. 孙国文, 卢明星, 吴蔚媚, 等. 薄型股前外侧皮瓣修复口腔软组织缺损. 中华整形外科杂志, 2013, 29(5): 321-324.
11. Rogers SN, Lowe D. The University of Washington Quality of LifeScale//Handbook of Disease Burdens and Quality of Life Measures. New York: Springer, 2010: 101-128.
12. Tarsitano A, Vietti MV, Cipriani R, et al. Functional results of microvascular reconstruction after hemiglossectomy: free anterolateral thigh flap versus free forearm flap. Acta Otorhinolaryngol Ital, 2013, 33(6): 374-379.
13. Chen SY, Lin WC, Deng SC, et al. Assessment of the perforators of anterolateral thigh flaps using 64-section multidetector computed tomographic angiography in head and neck cancer reconstruction. Eur J Surg Oncol, 2010, 36(10): 1004-1011.
14. Sheena Y, Jennison T, Hardwicke JT, et al. Reply: detection of perforators using thermal imaging. Plast Reconstr Surg, 2014, 134(5): 851e-852e.
15. Mathes DW, Neligan PC. Preoperative imaging techniques for perforator selection in abdomen-based microsurgical breast reconstruction. Clin Plast Surg, 2010, 37(4): 581-591.
16. Scott JR, Liu D, Said H, et al. Computed tomographic angiography in planning abdomen-based microsurgical breast reconstruction: a comparison with color duplex ultrasound. Plast Reconstr Surg, 2010, 125(2): 446-453.
17. Teunis T, Heerma van Voss MR, Kon M, et al. CT-angiography prior to DIEP flap breast reconstruction: a systematic review and meta-analysis. Microsurgery, 2013, 33(6): 496-502.
18. Sirimahachaiyakul P, Orfaniotis G, Gesakis K, et al. Keyhole anterolateral thigh flap: A special way of partition for reconstruction around a protruding structure or cavity/tunnel. Microsurgery, 2015, 35(5): 356-363.
19. Gong ZJ, Wang K, Tan HY, et al. Application of Thinned Anterolateral Thigh Flap for the Reconstruction of Head and Neck Defects. J Oral Maxillofac Surg, 2015, 73(7): 1410-1419.
20. Prasetyono TO, Bangun K, Buchari FB, et al. Practical considerations for perforator flap thinning procedures revisited. Arch Plast Surg, 2014, 41(6): 693-701.
21. 齐伟亚, 郑大伟, 张旭阳, 等. 血运重建后皮瓣修薄法在股前外侧皮瓣游离移植中的应用. 中国修复重建外科杂志, 2016, 30(4): 525-527.
22. 张文亚, 林森, 胡玉祥, 等. 游离修薄股前外侧穿支皮瓣的临床应用. 中华显微外科杂志, 2010, 33(1): 9-11.
23. George RK, Krishnamurthy A. Microsurgical free flaps: Controversies in maxillofacial reconstruction. Ann Maxillofac Surg, 2013, 3(1): 72-79.
24. 夏德林, 付光新, 马征, 等. 游离股前外侧肌皮瓣在舌癌术后缺损修复与舌再造中的应用. 中华整形外科杂志, 2011, 27(1): 8-11.
25. 罗世洪, 肖金刚, 孙黎波, 等. 股前外侧肌皮瓣及 CT 血管造影在修复中晚期口底癌术后缺损中的应用. 华西口腔医学杂志, 2015, 33(4): 409-413.
26. Zheng X, Zheng C, Wang B, et al. Reconstruction of complex soft-tissue defects in the extremities with chimeric anterolateral thigh perforator flap. Int J Surg, 2016, 26: 25-31.
27. Wang L, Liu K, Shao Z, et al. Individual design of the anterolateral thigh flap for functional reconstruction after hemiglossectomy: experience with 238 patients. Int J Oral Maxillofac Surg, 2016, 45(6): 726-730.
28. Ren ZH, Wu HJ, Wang K, et al. Anterolateral thigh myocutaneous flaps as the preferred flaps for reconstruction of oral and maxillofacial defects. J Craniomaxillofac Surg, 2014, 42(8): 1583-1589.