中国修复重建外科杂志

中国修复重建外科杂志

游离分叶股前外侧穿支皮瓣修复口腔颌面部恶性肿瘤术后颊部洞穿缺损

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目的 探讨应用游离分叶股前外侧穿支皮瓣修复口腔颌面部恶性肿瘤术后颊部洞穿缺损的临床效果。 方法 2008 年 1 月—2016 年 12 月,收治 42 例口腔颌面部恶性肿瘤患者。男 31 例,女 11 例;年龄 31~68 岁,平均 44.5 岁。口颊黏膜鳞癌 28 例,颊部皮肤基底细胞癌 10 例,牙龈鳞癌 3 例,腮腺复发导管癌 1 例。病程 1~24 个月,平均 13.5 个月。肿瘤根治性切除后遗留缺损范围为 6.0 cm×4.5 cm~9.0 cm×7.0 cm ;均为口颊洞穿缺损。设计并切取游离分叶股前外侧穿支皮瓣修复口内黏膜及颊部皮肤软组织缺损,皮瓣切取范围为 7 cm×5 cm~10 cm×8 cm 。供区直接拉拢缝合。 结果 手术时间 4.5~7.5 h ,平均 5.5 h 。所有皮瓣均顺利成活,供、受区切口均Ⅰ期愈合。术后患者均获随访,随访时间 9~60 个月,平均 22 个月。患者对颊面部外形满意,张口度为 3~5 cm ,语言功能恢复良好。供区仅遗留线性瘢痕。随访期间,3 例患者因肿瘤复发死亡,其余患者均无瘤生存。 结论 游离分叶股前外侧穿支皮瓣设计切取灵活,修复口腔颌面部恶性肿瘤术后颊部洞穿缺损效果满意。

Objective To investigate the effectiveness of bipaddled anterolateral thigh perforator flap in repair of through-and-through maxillofacial defect following oral cancer ablation. Methods Between January 2008 and December 2016, 42 patients with oral cancer were treated. There were 31 males and 11 females with an average age of 44.5 years (range, 31-68 years). There were 28 cases of buccal mucosa carcinoma, 10 cases of basal cell carcinoma of buccal skin, 3 cases of gingiva carcinoma, and 1 case of recurrent parotidduct carcinoma. The disease duration ranged from 1 to 24 months (mean, 13.5 months). The size of through-and-through maxillofacial defect ranged from 6.0 cm×4.5 cm to 9.0 cm×7.0 cm. All defects were repaired with the bipaddled anterolateral thigh perforator flap. The paddles were adjusted to repair the buccal area. And the size of flap ranged from 7 cm×5 cm to 10 cm×8 cm. The donor sites were closed directly. Results The operation time was 4.5-7.5 hours (mean, 5.5 hours). All flaps healed and the wounds of recipient and donor sites healed by first intention. All patients were followed up 9-60 months (mean, 22 months). All patients were satisfied with their facial appearance and the speech function. The range of mouth opening ranged from 3 to 5 cm. Three patients died of recurrence during the follow-up period and the other patients were alive. Conclusion The bipaddled anterolateral thigh perforator flap is flexible and reliable for the through-and-through maxillofacial defect reconstruction following oral cancer ablation.

关键词: 口腔恶性肿瘤; 洞穿缺损; 股前外侧穿支皮瓣; 皮瓣移植

Key words: Oral cancer; through-and-through defect; anterolateral thigh perforator flap; flap transplantation

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