筋膜上股前外侧皮瓣微创制备法在口腔颌面部软组织缺损修复重建中应用研究  

Minimally invasive harvest of suprafascial anterolateral thigh flap for soft tissue reconstruction

作　　者：王菲 李宁[1] 蒋灿华[1] 郭峰[1] 陈新群[1] 苏彤[1] 

机构地区：[1]中南大学湘雅医院口腔颌面外科,湖南长沙410008

出　　处：《中国实用口腔科杂志》2017年第12期720-723,共4页Chinese Journal of Practical Stomatology

摘　　要：目的探讨筋膜上股前外侧皮瓣(anterolateral thigh flap,ALTF)微创制备法在口腔颌面部软组织缺损修复重建中的应用价值。方法自2014年3月至2017年1月,中南大学湘雅医院口腔颌面外科共制备219例ALTF用于原发口腔鳞癌术后的软组织缺损修复重建,其中72例采用筋膜下制备法(筋膜下组),147例采用筋膜上制备法(筋膜上组)。比较两组的皮瓣制备时间、供区并发症(感染、血肿、切口裂开)和受区并发症(感染、血肿、口腔颈部瘘、皮瓣坏死)情况以及术后供区和受区的效果[从下肢瘢痕、下肢皮肤麻木、下肢皮肤触痛、下肢肌力以及口腔功能恢复(进食及语言)等方面进行评估]。结果筋膜上组的皮瓣制备时间较筋膜下组长(P<0.05)。两组皮瓣术后血管危象的发生率差异无统计学意义(P>0.05);筋膜上组供区切口裂开率较筋膜下法组低(P<0.05);其他供区和受区并发症两组无明显差别。筋膜上组患者术后下肢皮肤感觉异常者明显少于筋膜下组;术后1个月筋膜上组下肢肌力明显好于筋膜下组,但在术后6个月两组无明显差别。筋膜上组下肢瘢痕满意度显著好于筋膜下组,而两组术后语音和进食效果方面均无明显差异。结论筋膜上ALTF微创制备法对供区组织损伤更小,供区术后并发症更少,也更加符合微创外科的原则,值得推广。Objective To investigate the value of minimally invasive harvest of suprafascial anterolateral thigh flap （ALTF） in the repair of oral and maxillofaeial soft tissue defects. Methods Totally 219 cases who received ALTF for soft tissue reconstruction after oral squamous cell earcinona surgery from March 2014 to January 2017 were studied： 72 eases in the subfascial group, 147 in the suprafascial group. The harvest time, donor-site complications （infection, hematoma, wound rupture） and receipt-site complications （infection, hematoma, oral and neck fistula, flap necrosis） and the effect of donor-site and receipt-site （the thigh scar, the numbness of the skin of thigh, the dysesthesia of the skin of thigh, the muscle weakness and the functions of mouth） were observed. Results The harvest time of suprafascial group was more than subfaseial group （P 〈 0.05 ）. The cases with the numbness and dysesthesia of the skin of thigh in the suprafascial group were significantly fewer than in the subfaseial group. The muscle strength of the thigh in the subfascial group 1 month after operation was weaker than in the suprafaseial group, hut was similar 6 month after operation. Conclusion The suprafascial ALTF with minimal invasion can be applied in the repair of oral and maxillofacial defects after tumor resection.

关 键 词：股前外侧皮瓣 筋膜上制备 筋膜下制备 微创外科 修复重建 

分 类 号：R78[医药卫生—口腔医学]