腓动脉穿支双叶皮瓣在舌癌、口底癌术后缺损修复中的应用  

Application of peroneal artery perforator bilobed flap in repairing postoperative defects of tongue carcinoma and floor of mouth carcinoma

作　　者：许操 李建成[1] 宋培军[2] 杨东昆[1] 胡恺 陈默 董顺利 Xu Cao;Li Jiancheng;Song Peijun;Yang Dongkun;Hu Kai;Chen Mo;Dong Shunli(Department of Oral and Maxillofacial Surgery,the First Affiliated Hospital of Bengbu Medical College,Bengbu 233004,China;Department of Orthopedic Burn,the First Affiliated Hospital of Bengbu Medical College,Bengbu 233004,China)

机构地区：[1]蚌埠医学院第一附属医院口腔颌面外科,233004 [2]蚌埠医学院第一附属医院整形烧伤科,233004

出　　处：《中华整形外科杂志》2020年第8期893-898,共6页Chinese Journal of Plastic Surgery

基　　金：安徽省高校自然科学研究项目(KJ2019A0374)。

摘　　要：目的探讨腓动脉穿支双叶皮瓣在舌癌、口底癌术后缺损修复中的应用效果。方法2017年5月至2019年12月蚌埠医学院第一附属医院口腔颌面外科收治6例口腔鳞状细胞癌患者,男4例,女2例,年龄28~72岁。采用腓动脉穿支双叶皮瓣进行修复,一叶修复舌部,一叶修复口底,供区直接拉拢缝合。术后进行随访,观察有无肿瘤复发、转移,并评价患者的外形、张口度、吞咽功能、语言功能及下肢恢复情况等。结果6例患者中1例口底癌因分穿支血管蒂长度不足而采用单叶皮瓣;其余5例采用双叶皮瓣修复。5例皮瓣均成活,创面一期愈合;1例术后形成积液感染,经冲洗、换药后愈合。术后6个月,无患者出现肿瘤复发、转移,其中5例双叶瓣患者恢复接近正常状态,张口度Ⅱ~Ⅲ度;1例单叶瓣患者恢复一般,言语、吞咽功能仍受限。6例供区瘢痕隐蔽,下肢基本恢复正常。结论应用腓动脉穿支双叶皮瓣修复舌癌、口底癌术后缺损,可以取得较为满意的效果。Objective To investigate the application effect of bilobed skin flap with peroneal artery perforation in repairing postoperative defects of tongue cancer and oral floor cancer.Methods Six patients with oral squamous cell carcinoma(4 males and 2 females,aged 28-72 years)admitted to the Department of Oral and Maxillofacial Surgery,the First Affiliated Hospital of Benbu Medical College from May 2017 to December 2019 were repaired with the peroneal artery perforator bilobed flap,one lobe repaired the tongue,and the other repaired the floor of the mouth.The donor area is directly closed and sutured.Postoperative follow-up was conducted to observe tumor recurrence and metastasis,and the patient’s appearance,mouth opening,swallowing function,speech function and lower limb recovery were evaluated.Results All the 6 flaps survived.One of the patients had a single flap because the pedicle of the perforator vessel was not long enough.The other 5 cases were repaired with bilobed leaf flap.All the flaps survived and the wound surface healed in the first stage.One case was infected with effusion after operation,which was healed by washing and dressing change.The donor area can be sutured directly.No tumor recurrence or metastasis occurred 6 months after surgery.Speech,swallowing and lower limb movement basically returned to normal,facial morphology was basically symmetrical,and the degree of openingⅡ-Ⅲ.Six months after the operation,5 patients with bilobed valve returned to a nearly normal state with a degree of openingⅡ-Ⅲ.One patient with single lobe recovered moderately,but speech and swallowing were still restricted.In 6 cases,the donor scar was concealed and the lower limb was basically normal.Conclusions The bilobed flap with peroneal artery perforation can be used to repair postoperative defects of tongue carcinoma and floor of mouth carcinoma.

关 键 词：外科皮瓣 穿支皮瓣 舌肿瘤 口腔肿瘤 腓动脉 双叶皮瓣 

分 类 号：R739.86[医药卫生—肿瘤]