游离分叶股前外侧穿支皮瓣修复口腔颌面部恶性肿瘤术后颊部洞穿缺损  

Effectiveness of bipaddled anterolateral thigh perforator flap in repair of through-andthrough maxillofacial defect after oral cancer ablation

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] 彭翠娥[1] 彭文[1] 欧延[1] SONG Dajiang;LI Zan;ZHOU Xiao;ZHANG Yixin;PENG Xiaowei;ZHOU Bo;LV Chunliu;PENG Cuie;PENG Wen;OU Yan(Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Hunan Provincial Oncologic Plastic Surgery Clinical Research Center, Changsha Hunan, 410008, P.R.China;Department of Plastic and Reconstructive Surgery, the Ninth People＇s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200000, P.R.China)

机构地区：[1]湖南省肿瘤医院肿瘤整形外科湖南省肿瘤整形外科临床医学研究中心,长沙410008 [2]上海交通大学医学院附属第九人民医院整复外科,上海200000

出　　处：《中国修复重建外科杂志》2018年第5期607-611,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：湖南省自然科学基金面上项目(2018JJ2242;2018JJ2241);湖南省科技计划项目(2014SK3002);湖南省卫生与计划生育委员会课题项目(B2014-111);湖南省肿瘤整形外科临床医学研究中心平台建设专项资助(2013TP4087)~~

摘　　要：目的探讨应用游离分叶股前外侧穿支皮瓣修复口腔颌面部恶性肿瘤术后颊部洞穿缺损的临床效果。方法 2008年1月—2016年12月,收治42例口腔颌面部恶性肿瘤患者。男31例,女11例;年龄31～68岁,平均44.5岁。口颊黏膜鳞癌28例,颊部皮肤基底细胞癌10例,牙龈鳞癌3例,腮腺复发导管癌1例。病程1～24个月,平均13.5个月。肿瘤根治性切除后遗留缺损范围为6.0 cm×4.5 cm～9.0 cm×7.0 cm;均为颊部洞穿缺损。设计并切取游离分叶股前外侧穿支皮瓣修复口内黏膜及颊部皮肤软组织缺损,皮瓣切取范围为7 cm×5 cm～10 cm×8 cm。供区直接拉拢缝合。结果手术时间4.5～7.5 h,平均5.5 h。所有皮瓣均顺利成活,供、受区切口均Ⅰ期愈合。术后患者均获随访,随访时间9～60个月,平均22个月。患者对颊面部外形满意,张口度为3～5 cm,语言功能恢复良好。供区仅遗留线性瘢痕。随访期间,3例患者因肿瘤复发死亡,其余患者均无瘤生存。结论游离分叶股前外侧穿支皮瓣设计切取灵活,修复口腔颌面部恶性肿瘤术后颊部洞穿缺损效果满意。Objective To investigate the effectiveness of bipaddled anterolateral thigh perforator flap in repair of through-and-through maxillofacial defect following oral cancer ablation. Methods Between January 2008 and December2016,42 patients with oral cancer were treated. There were 31 males and 11 females with an average age of 44.5 years（range, 31-68 years）. There were 28 cases of buccal mucosa carcinoma, 10 cases of basal cell carcinoma of buccal skin,3 cases of gingiva carcinoma, and 1 case of recurrent parotidduct carcinoma. The disease duration ranged from 1 to24 months（mean, 13.5 months）. The size of through-and-through maxillofacial defect ranged from 6.0 cm×4.5 cm to9.0 cm×7.0 cm. All defects were repaired with the bipaddled anterolateral thigh perforator flap. The paddles were adjusted to repair the buccal area. And the size of flap ranged from 7 cm×5 cm to 10 cm×8 cm. The donor sites were closed directly.Results The operation time was 4.5-7.5 hours（mean, 5.5 hours）. All flaps healed and the wounds of recipient and donor sites healed by first intention. All patients were followed up 9-60 months（mean, 22 months）. All patients were satisfied with their facial appearance and the speech function. The range of mouth opening was 3-5 cm. Three patients died of recurrence during the follow-up period and the other patients were alive. Conclusion The bipaddled anterolateral thigh perforator flap is flexible and reliable for the through-and-through maxillofacial defect reconstruction following oral c ancer ablation.

关 键 词：口腔恶性肿瘤 洞穿缺损 股前外侧穿支皮瓣 皮瓣移植 

分 类 号：R739.81[医药卫生—肿瘤]