前臂皮瓣联合邻近组织瓣修复腭及上颌组织缺损早期疗效  

EARLY EFFECTIVENESS OF COMBINING RADIAL FOREARM FREE FLAP AND ADJACENT TISSUE FLAP IN RECONSTRUCTION OF PALATOMAXILLARY DEFECTS

作　　者：陈永锋[1] 张凯[1] 李建成[1] 徐锦程[1] 廖圣恺[1] 徐涛[1] 

机构地区：[1]蚌埠医学院第一附属医院口腔科,安徽蚌埠233004

出　　处：《中国修复重建外科杂志》2011年第9期1051-1054,共4页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：安徽省卫生厅临床医学应用项目(2008B016)~~

摘　　要：目的探讨游离前臂皮瓣联合邻近组织瓣修复腭、上颌组织缺损的方法和疗效。方法 2005年3月-2010年5月收治17例腭及上颌部肿瘤患者。男11例,女6例;年龄45～74岁,平均62.5岁。良性肿瘤1例;恶性肿瘤16例,其中腭部鳞状细胞癌7例,腭部鳞状细胞癌术后复发1例,腭部恶性黑色素瘤1例,腭部腺样囊腺癌1例,上颌恶性黑色素瘤1例,上颌导管癌1例,上颌鳞状细胞癌4例。病灶切除后缺损范围为7.0cm×5.5cm～10.0cm×7.5cm;根据Brown等对上颌骨缺损的分类标准,Ⅱ类15例,Ⅲ类2例;合并眶底、眶下缘骨质缺损2例。根据腭、上颌组织缺损类型,以游离前臂皮瓣联合颊脂垫行即刻修复11例,以游离前臂皮瓣联合颊脂垫及颞肌下颌骨骨肌瓣即刻修复6例。术后观察组织瓣成活情况及语言、吞咽、呼吸功能恢复情况及患者面部外形恢复情况。结果 17例前臂皮瓣和邻近组织瓣均成活;供区植皮均成活,切口均Ⅰ期愈合。患者均获随访,随访时间6～12个月。肿瘤无复发。患者语言、吞咽、呼吸基本正常,无明显开口受限,面部外形满意,无严重畸形。合并眶底、眶下缘骨质缺损者,未出现眼球内陷。患者术后均无明显口鼻瘘,口、鼻腔功能恢复满意。结论根据腭、上颌组织缺损的情况,选择游离前臂皮瓣联合颊脂垫或颊脂垫及下颌骨骨肌瓣进行修复,可达到较好的早期疗效。Objective To investigate the method of combining radial forearm free flap and adjacent tissue flap in reconstruction of palatomaxillary defects and its effectiveness.Methods Between March 2005 and May 2010,17 patients with palatomaxillary defects were treated.There were 11 males and 6 females with an age range of 45-74 years（mean,62.5 years）,including 1 case of benign tumor and 16 cases of malignant tumors（7 cases of squamous cell carcinoma of palate,1 case of recurring squamous cell carcinoma of palate,1 case of malignant melanoma of palate,1 case of adenoid cystic carcinoma of palate,1 case of malignant melanoma of maxilla,1 case of ductal carcinoma of maxilla,and 4 cases of squamous cell carcinoma of maxilla）.The maxillectomy defect ranged from 7.0 cm × 5.5 cm to 10.0 cm × 7.5 cm.According to Brown’s classification for the maxillectomy defect,there were type II in 15 cases,type III in 2 cases.Palatomaxillary defects were repaired with radial forearm free flap and buccal fat pad in 11 cases,and with radial forearm free flap,buccal fat pad,and mandibular osteomuscular flap pedicled with temporal muscle in 6 cases.The effectiveness was evaluated after operation by observing the vitality of the flap,the functions of speech,swallowing,breath,and the facial appearance.Results All cases were followed up 6-12 months without tumor recurrence.All flaps and skin grafts at donor sites survived.The functions of speech,swallowing,and breath were normal without obvious opening limitation.The facial appearance was satisfactory without obvious maxillofacial deformity.No enophthalmos occurred in patients with orbital floor and infraorbital rim defects.The patients had no oronasal fistula with satisfactory oral and nasal functions.Conclusion According to the type of palatomaxillary defects,it can have good early effectiveness to select combining radial forearm free flap and buccal fat pad or combining radial forearm free flap,buccal fat pad,and mandibular osteomuscular flap for repairing defects.

关 键 词：腭及上颌组织缺损 前臂皮瓣 颊脂垫 下颌骨骨肌瓣 

分 类 号：R782.2[医药卫生—口腔医学]