带阔筋膜股前外侧游离皮瓣修复头部鳞状细胞癌切除后硬脑膜缺损的效果  

Effects of anterolateral thigh free flap with fascia lata in repairing dura mater defect after resection of head squamous cell carcinoma

作　　者：韩夫 郑朝 王洪涛 官浩 计鹏 胡晓龙 佟琳 张智 陈俏华 冯爱娜 胡大海 Han Fu;Zheng Zhao;Wang Hongtao;Guan Hao;Ji Peng;Hu Xiaolong;Tong Lin;Zhang Zhi;Chen Qiaohua;Feng Aina;Hu Dahai(Department of Burns and Cutaneous Surgery,Burn Center of PLA,Xijing Hospital,Air Force Medical University,Xi'an 710032,China)

机构地区：[1]空军军医大学西京医院全军烧伤中心,烧伤与皮肤外科,西安710032

出　　处：《中华烧伤杂志》2020年第3期219-223,共5页Chinese Journal of Burns

基　　金：国家自然科学基金面上项目(81772071)。

摘　　要：目的评价应用带阔筋膜的股前外侧皮瓣游离移植修复头部鳞状细胞癌切除后硬脑膜缺损的临床疗效。方法2016年6月—2018年6月,空军军医大学西京医院收治12例头部鳞状细胞癌患者,其中男9例、女3例,年龄35~74岁,均采用带阔筋膜的股前外侧皮瓣游离移植修复肿瘤切除后硬脑膜缺损。本组患者肿瘤切除后头皮软组织缺损面积为12 cm×10 cm^24 cm×21 cm,硬脑膜缺损面积为7 cm×6 cm^16 cm×14 cm;皮瓣面积为14 cm×12 cm^27 cm×24 cm,阔筋膜面积为8 cm×7 cm^17 cm×15 cm。将颞浅动脉及颞中静脉与皮瓣供血血管旋股外侧动脉降支第1肌皮穿支及其伴行静脉分别端端吻合。供瓣区取自体躯干中厚皮移植修复并打包固定。术后观察患者皮瓣和皮片存活情况;定期随访,行头颅磁共振成像,观察颅内肿瘤是否复发和硬脑膜完整性,另观察皮瓣的外形、供瓣区是否遗留明显功能障碍。结果本组患者术后皮瓣和皮片均存活良好。10例患者皮瓣缝合边缘愈合;2例患者皮瓣缝合口局部窦道形成,少量脑脊液外漏,经门诊换药后痊愈。本组患者随访10~36个月,3例患者术后颅内肿瘤复发,均为肿瘤累及硬脑膜矢状窦区患者,再次切除肿瘤;所有患者硬脑膜完整,皮瓣外形较佳,供瓣区切取后未遗留明显功能障碍。结论采用带阔筋膜的股前外侧皮瓣游离移植修复头部鳞状细胞癌切除后硬脑膜缺损是一种有效、可靠的方法,能较好修复因鳞状细胞癌侵犯切除头皮及硬脑膜形成的缺损,并为颅骨重建提供有利条件。Objective To evaluate the clinical effects of anterolateral thigh free flap with fascia lata in the repair of dura mater defect after resection of head squamous cell carcinoma.Methods From June 2016 to June 2018,Xijing Hospital of Air Force Medical University applied the free transplantation of anterolateral thigh flap with fascia lata to repair the dura mater defect of 12 patients with head squamous cell carcinoma,including 9 males and 3 females,aged from 35 to 74 years.The size of scalp soft tissue defects in patients after carcinoma resection ranged from 12 cm×10 cm to 24 cm×21 cm,and the size of dura mater defect of patients ranged from 7 cm×6 cm to 16 cm×14 cm.The size of flap of patients ranged from 14 cm×12 cm to 27 cm×24 cm,and the size of fascia lata ranged from 8 cm×7 cm to 17 cm×15 cm.The superficial temporal artery and middle temporal vein were connected by end to end anastomosis with the first musculocutaneous perforating branch of the descending branch of lateral femoral artery and its accompanying vein.The flap donor area was transplanted with autologous split-thickness skin graft from trunk and fixed with packing.Postoperative survival of flaps and skin grafts was observed.The patients were followed up regularly.The cranial magnetic resonance imaging was performed to observe the recurrence of intracranial tumors and dural integrity,shape of the flap and whether the donor site region was left with significant dysfunction were observed.Results All the flaps and skin grafts survived well in 12 patients after surgery.Ten patients had primary healing at the edge of the flap suture;2 patients had local sinus tract formation at the suture site of flap,with a small amount of cerebrospinal fluid leakage,and were recovered after outpatient dressing change.The patients were followed up for 10 to 36 months,and 3 patients with tumors involving in the dura mater sagittal sinus region had postoperative intracranial tumor recurrence.The tumor was resected again.All the patients had good dural integrity.Th

关 键 词：癌 鳞状细胞 阔筋膜 股前外侧皮瓣 硬脑膜缺损 

分 类 号：R644[医药卫生—外科学]