斜方肌肌皮瓣联合肩胛骨肌皮瓣修复晚期头颈肿瘤术后下颌骨贯穿性缺损6例报道  

Combined bilobed trapezius myocutaneous and scapula osteomyocutaneous flaps for reconstructing a through-and-through defect of the mandible following salvage surgery for recurrent head and neck tumors: report of 6 consecutive cases

作　　者：林钊宇[1] 周斌[1] 陈伟良[1] 汪延[1] 陈睿[1] 钟江龙 LIN Zhao-yu;ZHOU Bin;CHEN Wei-liang;WANG Yan;CHEN Rui;ZHONG Jiang-long(Department of Oral and Maxillofacial Surgery,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510120,Guangdong Province,China)

机构地区：[1]中山大学孙逸仙纪念医院口腔颌面外科,广东广州510120

出　　处：《中国口腔颌面外科杂志》2020年第5期447-450,共4页China Journal of Oral and Maxillofacial Surgery

基　　金：国家自然科学基金(81702695,81772888)。

摘　　要：目的 :评估斜方肌肌皮瓣联合肩胛骨肌皮瓣重建下颌骨洞穿性缺损的效果。方法 :对6例复发性晚期头颈恶性肿瘤患者进行挽救性手术,均通过基于颈横血管系统(TCVs)的斜方肌肌皮瓣和肩胛骨骨肌皮瓣修复肿瘤根治术后下颌骨洞穿性缺损。结果:所有患者均具有骨组织和广泛的软组织缺损,其中下颌骨缺损类型包括4例H型,1例LCL型和1例C型缺损,挽救性手术后存在洞穿性软组织缺损。所有肿瘤均可被整块切除,无严重并发症。其中2例出现轻微并发症:1例出现口内皮瓣轻微坏死,1例皮瓣供区的部分伤口裂开。所有患者不需要鼻饲饮食,面部和颈部外观均令人满意或可接受,未表现出上肢运动严重受限。随访10~18个月,5例患者无复发迹象。结论:基于颈横血管系统(TCVs)的斜方肌肌皮瓣和肩胛骨骨肌皮瓣可作为重建颅面部洞穿性缺损的有效方法,修复晚期头颈部肿瘤患者挽救性手术的术后缺损,可达到令人满意的功能和美学效果。PURPOSE: To evaluate the outcomes of reconstructing through-and-through defects of the mandible.METHODS: The subjects were six patients with recurrent malignant tumors who underwent salvage surgery and reconstruction with combined bilobed trapezius myocutaneous and scapula osteomyocutaneous flaps based on the transverse cervical vessels(TCVs). RESULTS: All patients had combined bone and extensive soft tissue defects,including four cases of type H, one type LCL and one type C mandible defects and through-and-through soft tissue defects following salvage surgery. All tumors were removed and the complex defects were reconstructed successfully. Two patients experienced minor complications: one minor intraoral flap failure and one case of wound dehiscence at the donor site. None of the patients required nasogastric tube feeding;the appearance of the face and neck was satisfactory or acceptable in all patients. No patient showed severely limited range of motion of the upper limb. The patients were followed for 10 to 18 months. Five patients were alive with no evidence of disease. CONCLUSIONS: The use of combined bilobed trapezius myocutaneous and scapula osteomyocutaneous flaps based on the TCVs may be an effective approach for reconstructing through-and-through defects of the mandible and may provide satisfactory or acceptable functional and esthetic outcomes following salvage surgery for advanced head and neck tumors.

关 键 词：斜方肌皮瓣 肩胛骨肌皮瓣 颈横血管 头颈肿瘤 复发 挽救性手术 下颌骨缺损 

分 类 号：R782.05[医药卫生—口腔医学]