不同血管蒂来源的游离股内侧穿支皮瓣在颊黏膜癌术后缺损修复中的应用  

Free medial thigh perforator flaps with various pedicle origins for the reconstruction of defect after buccal mucosa squamous cell carcinoma resection

作　　者：宋达疆[1] 李赞[1] 周晓[1] 章一新[2] 彭小伟[1] 周波[1] 吕春柳[1] 彭文[1] 欧延[1] Song Dajiang;Li Zan;Zhou Xiao;Zhang Yixin;Peng Xiaowei;Zhou Bo;Lyu Chunliu;Peng Wen;Ou Yan(Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410008, China;Shanghai Ninth People＇s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, China)

机构地区：[1]湖南省肿瘤医院肿瘤整形外科,长沙410008 [2]上海交通大学医学院附属第九人民医院整形外科,200011

出　　处：《中华耳鼻咽喉头颈外科杂志》2017年第12期890-894,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：湖南省自然科学基金（13JJ5012）;湖南省科技计划（2014SK3002）;湖南省卫计委课题（B2014-111）

摘　　要：目的 探讨不同血管蒂来源的游离股内侧穿支皮瓣在颊黏膜癌术后缺损修复中的应用.方法 2015年1月至2016年12月,湖南省肿瘤医院肿瘤整形外科应用不同血管蒂来源的游离股内侧穿支皮瓣对32例颊黏膜癌患者根治术后同期行口颊缺损修复.其中男27例,女5例;年龄36 ～71岁,平均45.2岁.按国际抗癌联盟（UICC） TNM分期：T4N0M0 13例,T4N1 M0 12例,T3N1M05例,T3 N2M0 2例.病程1～ 30个月,平均9.6个月.结果 皮瓣切取范围为8.0 cm×3.5 cm～15.5 cm×6.0 cm,皮瓣厚度为2.0～4.5 cm.其中19例采用游离股深动脉蒂股薄肌穿支皮瓣,股薄肌穿支血管蒂长度为（8.7 ±0.4）cm;9例采用游离股深动脉蒂大收肌穿支皮瓣,大收肌穿支血管蒂长度为（9.5±0.4） cm;4例采用游离股动脉蒂股内侧穿支皮瓣,股动脉穿支血管蒂长度为（6.9±0.5） cm.32例股内侧穿支皮瓣全部存活,供区均直接闭合.随访8～ 32个月.皮瓣形态良好,肿瘤局部无复发.供区仅遗留线性瘢痕,大腿功能未见明显影响.结论 游离股内侧穿支皮瓣是颊黏膜癌术后缺损修复的理想选择之一.Objective To explore investigate the application of free medial thigh perforator flaps with different pedicle origins in the reconstruction of defect after radical resection of buccal mucosa squamous cell carcinoma.Methods From January 2015 to December 2016,32 cases with buccal mucosa squamous cell carcinoma underwent radical resection and buccal mucosa defect after surgery was reconstructed by free medial thigh perforator flap at the same stage.The patients included 32 males and 5 females,ranged in age from 36 to 71 years （45.2 years on average）.According to UICC stage：T4N0M0 13 cases,T4N1M0 12 cases,T3N1M0 5 cases,T3N2M0 2 cases.The course ranged from 1 to 30 months （9.6 months on average）.Results The perforator flaps ranged from 8.0 cm × 3.5 cm to 15.5 cm × 6.0 cm in size,from 2.0 to 4.5 cm in thickness.The mean length of pedicles from gracilis muscle was （8.7 ± 0.4） cm in 19 cases,the mean length of pedicles from adductor magnus muscle was （9.5 ±0.4） cm in 9 cases and the length of pedicles from femoral artery was （6.9 ± 0.5） cm in 4 cases.All 44 perforator flaps survived uneventfully.The donor sites in the medial thigh were closed directly and healed well in all cases.Patients were followed up for 8 to 32 months with satisfied esthetic and functional results in reconstructed tongue,with no local recurrence.Only linear scars left in the donor sites,the functions of thighs were not affected.Conclusion The free medial thigh perforator flap is an idea choice to reconstruct the defect after radical resection of buccal mucosa squamous cell carcinoma.

关 键 词：外科皮瓣 口腔肿瘤 股动脉 修复外科手术 

分 类 号：R739.8[医药卫生—肿瘤]