股前内侧穿支皮瓣修复口腔癌缺损的效果  

Effect of anteromedial thigh perforator flap on repair of defects caused by oral cancer surgery

作　　者：宋达疆[1] 李赞[1] 章一新[2] 彭小伟[1] 冯光[3] 周波[1] 吕春柳[1] 伍鹏 唐园园 易亮 罗振华 Song Dajiang;Li Zan;Zhang Yixin;Peng Xiaowei;Feng Guang;Zhou Bo;Lyu Chunliu;Wu Peng;Tang Yuanyuan;Yi Liang;Luo Zhenhua(Department of Oncolog Plastic Surgery,Hunan Cancer Hospital,Changsha 410008,China;Department of Plastic and Reconstructive Surgery,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China;Department of Burns and Plastic Surgery,the Fourth Medical Center of PLA General Hospital,Beijing 100048,China)

机构地区：[1]湖南省肿瘤医院肿瘤整形外科,长沙410008 [2]上海交通大学医学院附属第九人民医院整形外科,200011 [3]解放军总医院第四医学中心烧伤整形科,北京100048

出　　处：《中华医学美学美容杂志》2020年第5期398-401,共4页Chinese Journal of Medical Aesthetics and Cosmetology

基　　金：湖南省自然科学基金(2018JJ2241、2018JJ2242);湖南省科卫联合项目(2018JJ6028);湖南省卫健委课题(B2019092);长沙市科技计划基础研究项目(kq1901074、kq1901077);湖南省肿瘤整形外科临床医学研究中心平台建设专项(2013TP4087)。

摘　　要：目的探讨股前内侧皮瓣修复口腔癌缺损、供区采用股前区接力皮瓣修复的优势和经验。方法2016年2月至2018年12月,湖南省肿瘤医院肿瘤整形外科收治13例口腔肿瘤患者,男11例,女2例;年龄28~74岁,平均49.5岁;其中舌癌8例、口颊癌5例。全部采用游离股前内侧皮瓣移植修复口腔缺损。结果13例患者游离股前内侧穿支皮瓣都顺利切取成功,皮瓣面积7.0 cm×4.0 cm^14.0 cm×7.5 cm,皮瓣供区采用股前外侧接力穿支皮瓣(10例)或股前内侧接力穿支皮瓣(3例)转移修复,接力股前外侧穿支皮瓣面积为8.5 cm×5.0 cm^18.0 cm×7.0 cm,接力股前内侧穿支皮瓣面积为7.5 cm×4.0 cm^15.0 cm×7.0 cm。术后所有皮瓣全部顺利成活,愈合良好,未发生血管危象和伤口裂开感染等情况。术后随访12~28个月,皮瓣全部成活良好,皮瓣供区仅遗留线性瘢痕,颜色及外观轮廓自然,大腿功能未见明显影响。结论当游离股前外侧皮瓣切取困难时,用游离股前内侧皮瓣修复口腔肿瘤缺损,皮瓣供区直接闭合张力较大时以股前区接力皮瓣修复,可缩短手术时间,改善手术效果。Objective To introduce the advantages and clinical experience of relaying antero thigh flap in the resurfacing of the donor defect after anteromedial thigh(AMT)flap transfer for oral cancer defect reconstruction.Methods The number,courses and location of antero thigh perforators were recorded in 6 adult specimens,(3 male and 3 female).Specimen was produced via femoral artery perfusion after joining lead oxide red setting,up to the inguinal ligament,down to the superior margin of patella,lateral to the lateral femoral intermuscular septum,medial near the lateral margin of adductor longus muscle.From February 2016 to December 2018 in Hunan Provincial Cancer Hospital,13 cases(11 male and 2 female)with oral carcinoma(8 tongue carcinoma and 5 buccal cancer),leaving tongue or mouth defects which were reconstructed by free AMT perforator flaps.Results All free AMT flaps were harvested smoothly,the flap size ranged from 7.5 cm×4.5 cm to 13.0 cm×7.5 cm,the donor sites were reconstructed with relaying ALT flaps in 10 cases,with relaying AMT flaps in 3 cases,the relaying ALT flap size ranged from 8.5 cm×5.0 cm to 18.0 cm×7.0 cm,the relaying AMT flap size ranged from 7.5 cm×4.0 cm to 15.0 cm×7.0 cm.All flaps survived uneventfully,no vascular crisis or wound dehiscence,infection occurred.All patients were followed up for 12~28 months,all flaps healed smoothly,only linear scar was left in the donor sites,the color,appearance and contour of flaps were natural,and the function of thighs were not affected.Conclusions When it is difficult to elevate the free anterolateral thigh flap,the free anteromedial thigh flap can be used to repair the oral cancer defect.When the direct closure of the flap donor area is of big tension,the relaying antero flap can be used to reconstruct the donor site,minimize the operation time and improve the outcome.

关 键 词：口腔肿瘤 接力皮瓣 股前外侧穿支皮瓣 游离皮瓣移植 股前内侧穿支皮瓣 

分 类 号：R739.8[医药卫生—肿瘤]