带感觉神经与失神经的股前外侧穿支皮瓣在头颈部感觉重建的对比研究  

A comparative study of anterolateral thigh perforator flap with and without sensory nerve graft for sensation reconstruction in head and neck region

作　　者：杨何平 张洪武 杨书雄 王君 胡达旺 

机构地区：[1]湖南省湘潭市中心医院口腔颌面外科,湖南省湘潭市411100

出　　处：《中华显微外科杂志》2016年第3期225-229,共5页Chinese Journal of Microsurgery

基　　金：湘潭市科技计划项目（ZJ20131018）

摘　　要：目的对比研究吻合感觉神经的股前外侧穿支皮瓣与失神经移植皮瓣在头颈肿瘤术后缺损修复中的感觉重建效果。方法选取2011年5月至2015年5月应用股前外侧穿支皮瓣重建头颈部肿瘤术后缺损76例，其中吻合感觉神经的股前外侧穿支皮瓣35例（A组），失神经移植的股前外侧穿支皮瓣41例（B组）。比较两组患者的治疗效果，治疗效果用甲级、乙级和丙级表示。结果76例皮瓣均成活，患者面部外形恢复良好，供区伤口I期愈合。随访24周，A组治疗效果甲级、乙级、丙级分别为65．71％、28．57％、5．72％，而B组则分别为31．70％、26．84％、41．46％，A组的治疗效果优于B组，术后并发症少于B组（P〈0．05）。结论与失神经移植的股前外侧穿支皮瓣相比，通过吻合感觉神经的股前外侧穿支皮瓣修复头颈部肿瘤术后缺损，可在一定程度上恢复皮瓣的感觉功能，对头颈部缺损功能修复有重要意义。Objective To compare the operation effects of sensation restoration after tumor resection in the head and neck defects reconstruction by anterolateral thigh flap with or without sensory nerve transplantation. Methods The application of 76 cases anterolateral thigh flaps in head and neck defects reconstruction after tumor resection from May, 2011 to May, 2015 were observed. 35 patients underwent simultaneous reconstruction with sen- sory nerve anastomosed perforator based anterolateral thigh flap and 41 patients underwent simultaneous reconstruc- tion without sensory nerve graft based antero[ateral thigh flap, which was named as group A and group B, respective ly. The treatment effectiveness of the two groups was compared and graded into First, Second and Third rate. Results All the 76 flaps survived. Satisfying morphology for the maxillofacial region and stage-one healing for the donor site was available. During the 24-week follow-up, group A were 65.71% （First rate）, 28.57% （Second rate）, 5.72%（Third rate） respectively, and the condition of group B were 31.70%, 26.84%, 41.46%. The treatment effec- tiveness of group A was better than that of group B. Postoperative complications were less than group B（P 〈 0.05）. Conclusion Compared with the loss of nerve transplantation of anterolateral thigh perforator flap, sensory nerve anastomosed perforator based anterolateral thigh flap is of great value to reconstruct the defect after resection of tumor in head and neck region and restore the sensation of flap.

关 键 词：头颈部 修复 股前外侧穿支皮瓣 感觉重建 

分 类 号：R739.91[医药卫生—肿瘤] R782.2[医药卫生—临床医学]