游离股前外侧肌皮瓣在上颌窦恶性肿瘤术后缺损修复中的应用  

Clinical application of free anterolateral thigh flap with muscles in the reconstruction of facial defect after maxillectomy in malignant tumor

作　　者：马泓智[1] 房居高[1] 钟琦[1] 侯丽珍[1] 李平栋[1] 冯凌[1] 

机构地区：[1]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科,耳鼻咽喉头颈科学教育部重点实验室(首都医科大学),头颈部分子病理诊断北京市重点实验室,北京100730

出　　处：《中国耳鼻咽喉头颈外科》2017年第11期561-564,共4页Chinese Archives of Otolaryngology-Head and Neck Surgery

基　　金：国家自然科学基金资助项目(81473499)

摘　　要：目的探讨股前外侧肌皮瓣对上颌骨缺损修复的功能与美容效果。方法回顾2016年6月~2017年6月股前外侧肌皮瓣修复上颌骨术后缺损的5例中晚期(T3~T4N0M0)上颌骨恶性肿瘤的临床资料,均行上颌骨全切及扩大切除。采用股前外侧肌皮瓣进行重建,组织量约为缺损量的1.25倍。结果 5例患者术中所取组织量在165~225 ml之间,取瓣时间80~95 min。术后皮瓣均成活,术后1个月放疗前修复侧颜面较正常侧肿胀,但放疗后双侧颜面基本对称,均无复视,鼻腔通气良好,进食正常,腿部无运动障碍。结论应用游离股前外侧肌皮瓣修复上颌窦恶性肿瘤切除后的缺损,组织量充足可调,远期外形特别是放疗后形象优于常规仅用皮肤瓣修复者,鼻眼及进食功能好,简便易于操作。OBJECTIVE To study the effect of the free anterolateral thigh myocutaneous flap on the appearance and functions after maxillectomy. METHODS The clinical data of 5 patients with malignant maxillary tumors from June, 2016 to June 2017 were analyzed retrospectively. The 5 cases were T3-4NOM0 lesions. All of them received the maxillectomy and then were reconstructed with the free anterolateral thigh myocutaneous flap, and the flap was about 1.25 times of the defect in volume. RESULTS The needed volumes for the reconstruction were from 165 ml to 225 ml and the operation time of reconstruction were between 80-95 minutes. All the free flaps survived after operation. Although the reconstructed side looked swelling obviously in the first month after surgery, the appearance became good and symmetrical after the radiotherapy. No diplopia occurred and the functions of breathing, swallowing and speaking were normal. No movement disorders happened caused by the donor of thigh flap. CONCLUSION The free anterolateral thigh myocutaneous flap as the reconstructive tissue has many merits. The volume is adequate and can be regulated according to the defect. The forward appearance is better than the free anterolateral thigh flap without muscles. So the reconstruction of free anterolateral thigh myocutaneous flap is an ideal material for reconstruction because of the good functions and being easy to operate.

关 键 词：上颌窦肿瘤 修复外科手术 外科皮瓣 旋股外动脉 

分 类 号：R739.8[医药卫生—肿瘤]