四种组织瓣移植修复颊部洞穿缺损的比较研究  

Comparative studies on indication and effectiveness of reconstruction of through-and-through cheek defects using four flaps

作　　者：张森林[1] 曹罡[1] 董震[1] 陈伟[1] 徐金科[1] 刘秉尧[1] 孟昭业[1] 

机构地区：[1]南京军区南京总医院口腔科,江苏南京210002

出　　处：《临床口腔医学杂志》2011年第7期429-432,共4页Journal of Clinical Stomatology

摘　　要：目的:比较折叠双皮岛游离前臂皮瓣、腹直肌皮瓣、股前外侧皮瓣和带蒂的胸大肌皮瓣移植修复颊部洞穿缺损的适应症和效果。方法:自2002年2月～2010年6月收治15例口腔颌面部恶性肿瘤患者,肿瘤根治性切除后遗留的颊部洞穿缺损大小范围(包括皮肤和黏膜):32-76 cm2。根据患者的年龄、性别、体型及缺损的部位和大小等情况,分别采用游离前臂皮瓣(3例)、腹直肌皮瓣(4例)、股前外侧皮瓣(2例)或带蒂胸大肌皮瓣(6例)折叠修复,分析和评价修复效果。结果:本组15例随访3个月～7年,除2例胸大肌皮瓣远端小部分坏死外,其余移植皮瓣均成活。面部外形恢复良好,张口不受限。结论:前臂皮瓣较薄,适于修复上颊部或前颊部洞穿缺损,腹直肌皮瓣和胸大肌皮瓣较厚,适于修复伴下颌骨缺损的下颊部和后颊部洞穿缺损,股前外侧皮瓣厚度中等,并可根据需要削薄,适于修复颊部任何区域的洞穿缺损。Objective：To analysis the indication and effectiveness of reconstruction of through-and-through cheek defects using folded double-skin paddle free forearm flap,rectus abdominis myocutaneous flap and anterolateral thigh flap and pedicle pectoralis major myocutaneous flap.Method：Fifteen cases with malignant tumors of oral and maxillofacial regions were reviewed from February 2002 to June 2010,and sizes of through-and-through cheek defects（including skin and mucosa） ranged from 32 cm2 to 76 cm2 after tumor resection.The defects were reconstructed with folded double-skin paddle free forearm flap in 3 cases,rectus abdominis myocutaneous flap in 4 cases and anterolateral thigh flap in 2 cases,and pedicle pectoralis major myocutaneous flap in 6 cases,choosing of the flaps according to age,sex and body type of the patients and position and size of defects.Data concerning functional impairment,aesthetic outcome and donor site morbidity were analyzed.Result：Fifteen cases were followed from 3 months to 7 years.In two cases,10 % or less of the skin paddle of pectoralis major myocutaneous flap exhibited necrosis,and the other 13 flaps survived completely.The contour and function of cheeks were restored well in all 15 cases.Conclusion：Forearm flap is thin and suitable for through-and-through tempora and pregena defect reconstruction,and rectus abdominis myocutaneous flap and pectoralis major myocutaneous flap are thick and good alternatives for through-and-through jowl and postgena defect reconstruction.Anterolateral thigh flap is an optimal choice for reconstruction of through-and-through cheek defect because of its versatility in size and thickness.

关 键 词：前臂皮瓣 腹直肌皮瓣 股前外侧皮瓣 胸大肌皮瓣 颊部洞穿缺损 显微外科 

分 类 号：R622.1[医药卫生—整形外科]