应用新型"V"形前臂皮瓣修复颊癌术后软组织缺损  

Application of a new V-shaped forearm flap in reconstruction of buccal cancer

作　　者：韩生伟 李浩[1] 刘锐[1] 宋传慧 尹西腾 刘喆 梁易 韩伟[1] HAN Shengwei;LI Hao;LIU Rui;SONG Chuanhui;YIN Xiteng;LIU Zhe;LIANG Yi;HAN Wei(Department of Oral and Maxillofacial Surgery,Nanjing Stomatological Hospital,Medical School of Nanjing University,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属口腔医院口腔颌面外科,南京210008

出　　处：《中华显微外科杂志》2021年第3期279-282,共4页Chinese Journal of Microsurgery

基　　金：国家自然科学基金(82002864);江苏省自然科学基金(BK20180138)。

摘　　要：目的探讨设计制备新型"V"形前臂皮瓣后供区直接关闭的可能性及其在颊癌软组织缺损修复重建中的应用价值。方法2018年10月至2019年9月,对10例颊癌患者行"V"形前臂皮瓣切取修复颊癌术后软组织缺损,该新型皮瓣在既往传统Kiss皮瓣基础上进行改良,在皮瓣制备过程中"V"形皮瓣两侧亚单位连接处不断开,从而保证连接处尖端的血运,同时还可使得对位缝合后的皮瓣尖端更圆滑,使得血运更佳。其中男6例,女4例。年龄35-63岁,平均48.3岁,皮瓣大小为3.0 cm×5.0 cm-4.0 cm×6.0 cm。术后3个月通过门诊随访对供区切口愈合及前臂外观等情况进行记录和评价,并分别测量患者腕关节的掌屈、背伸、桡偏、尺偏角度,同时对患者腕关节功能依照Gartland-Werley表进行评分。数据使用独立样本t检验进行统计分析,通过与术前数据对比,评估患者术后腕关节功能恢复状况。术后定期随访。结果10例患者前臂皮瓣切取后产生的供区创面均顺利关闭而无需植皮。其中3例患者术后因切缘张力过大发生创口缺血性改变,表皮剥脱后色素丧失,但切口愈合未受影响。术后随访期间所有患者前臂切口均未见明显瘢痕增生,外观满意。术前患者的掌屈、背伸、桡偏、尺偏角度分别为(57.8±1.3)°、(58.4±0.7)°、(18.2±0.5)°、(28.5±1.1)°,术后分别为(53.2±2.1)°、(55.3±1.8)°、(16.4±0.4)°、(25.4±1.4)°,各数据术前、后比较差异无统计学意义(P>0.05)。按Gartland-Werley标准评估10例患者术前与术后3个月腕关节功能,结果发现术前与术后优良率均为100%。结论使用新型"V"形游离前臂皮瓣可以直接关闭中小型前臂皮瓣切取后供区缺损,避免传统游离植皮的创伤及相关并发症,术后外观满意且不会对腕关节功能产生不良影响,是修复颊癌软组织缺损一种比较满意的方法,值得临床推广应用。Objective To design a new V-shaped forearm flap and to investigate the possibility of direct donor site closure and its value in the reconstruction of soft tissue defect after resection of buccal carcinoma.Methods The new V-shaped forearm flap technique was applied in 10 patients with buccal carcinoma from October,2018 to September,2019.There were 6 males and 4 females aged from 35 to 63 years(48.3 years in average).Flap size ranged from 3.0 cm×5.0 cm to 4.0 cm×6.0 cm.Wound healing and the appearance forearm were recorded and evaluated three months after the surgery.Radial deviation angle,wrist flexion,ulnar deviation and dorsal extension were measured and calculated 3 months after the surgery.The wrist function was evaluated according to the Gartland-Werley scale.The recovery of wrist function was evaluated by comparing with the preoperative data.Results Forearm donor sites were successfully closed without skin grafting in all 10 patients.Skin ischemia caused by excessive tension was observed at the incision edge in 3 patients,therefore leading to skin exfoliation and pigment loss without affecting wound healing.All patients were presented a cosmetic outcome during the follow-up period.No scar hyperplasia was observed.No significant difference was observed in perioperative wrist flexion angle,dorsal extension angle,radial deviation angle,ulnar deviation angle(P>0.05)[data before surgery were(57.8±1.3)°,(58.4±0.7)°,(18.2±0.5)°,(28.5±1.1)°respectively,and data 3 months after surgery were(53.2±2.1)°,(55.3±1.8)°,(16.4±0.4)°,(25.4±1.4)°respectively];Excellent and good rate of Gartland-Werley wrist score before and after surgery were both 100%.Conclusion The new V-shaped free forearm flap can directly close small to medium forearm flap donor site.This method could avoid the trauma and complications of traditional free skin graft.The postoperative appearance on donor site is satisfactory and will not have adverse effects on wrist function.The new V-shaped free forearm flap is a novel method for repair

关 键 词：颊癌 前臂皮瓣 软组织缺损 供区 显微外科技术 

分 类 号：R739.8[医药卫生—肿瘤]