股前外侧皮瓣在口腔颌面部缺损修复中的应用  

Clinical application of free anterolateral thigh flap in the reconstruction of oromaxillo-facial defects

作　　者：王铠[1] 谭宏宇[1] 吴汉江[1] 朱兆夫[1] 刘金兵[1] 龚朝建[1] 

机构地区：[1]中南大学湘雅二医院口腔科,长沙410011

出　　处：《中华耳鼻咽喉头颈外科杂志》2009年第9期753-757,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的探讨修复各类口腔颌面部缺损时应用游离股前外侧皮瓣的可能性和实用性。方法2007年1月至2008年12月共开展股前外侧皮瓣移植术172例，皮瓣最小面积4cm×4cm，最大面积10cm×25cm；修复缺损部位有舌部106例，颊部14例，口底15例，下唇颏部1例，硬软腭6例，上颌3例，下颌18例，口咽部2例，面部大面积缺损3例，颈肩部1例和颞下凹3例。其中，肌皮瓣151例，其次为筋膜皮瓣13例和嵌合皮瓣8例。结果游离股前外侧皮瓣的临床成活率为98．3％（169／172）。术后血管危象4例，其中1例抢救成功，3例组织瓣坏死。皮瓣边缘部分坏死3例，术后出血1例。腮腺区积液和腮腺瘘6例，口底瘘8例，感染6例，大腿皮瓣供区感染及皮肤部分坏死3例。术后患者均获得可接受的面部外形以及咀嚼、吞咽和语言功能。结论游离股前外侧皮瓣可以修复口腔颌面部各种复杂的缺损。Objective To analyze the possibility and practicality of using free anterolateral thigh flap to repair defects of oromaxillo-facial region. Methods One hundred and seventy-two patients underwent anterolateral thigh flap （ALP） reconstruction from Jan. 2007 to Dec. 2008. The size of the defect ranges from 4 cm × 4 cm to 10 cm ×25 cm. One hundred and six flaps were used for tongue reconstruction, 14 flaps for buccal reconstruction, 15 flaps for mouth floor reconstruction, 1 flap for lower lip and mental region reconstruction,6 flaps for hard and soft palate reconstruction, 3 flap for maxillar part reconstruction, 18 flaps for submaxilla part reconstruction,2 flaps for pharynx oralis reconstruction,3 flaps for repairing large-area defect of facial, 1 flap for repairing neck and shoulder region and 3 flaps for repairing defect of Infratemporal fossa. Of these flaps, 151 were musculocutaneous flaps, 13 were fasciocutaneous flaps and 8 were chimeric flaps. Results The success rate reaches 98.3% （ 169 of 172 ）. Postoperatively, 4 cases encountered vascular crisis, 1 of which survived completely with successful vessel exploration, 3 cases with partial necrosis; and 3 cases with complete necrosis. One case with bleeding after operation. Six cases with parotid fluidly and parotid fistula, 8 cases with mouth floor fistula, 6 cases with infection, 3 cases with infection and partial necrosis on the lateral thigh. All patients achieved acceptable contour, appearance and function. Conclusion Free anterolateral thigh flap can repair kinds of complicated defects on oromaxillofacial region.

关 键 词：外科皮瓣 修复外科手术 口腔肿瘤 移植 自体 

分 类 号：R686[医药卫生—骨科学]