面侧区肿瘤术后复杂缺损分类及修复重建的探讨  

Classification and reconstruction of complex defects after lateral facial tumor surgery

作　　者：张海林[1] 陈杰[1] 黄文孝[1] 谭平清[1] 王俊琦[1] 谢李[1] 钟外生[1] 黄鹏鑫 谭浩蕾[1] 包荣华[1] Zhang Hailin;Chen Jie;Huang Wenxiao;Tan Pingqing;Wang Junqi;Xie Li;Zhong Waisheng;Huang Pengxin;Tan Haolei;Bao Ronghua(Department of Head and Neck Surgery,Hunan Cancer Hospital,Changsha 410013,China)

机构地区：[1]湖南省肿瘤医院头颈外科,长沙410013

出　　处：《中华耳鼻咽喉头颈外科杂志》2021年第11期1144-1149,共6页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：湖南省卫生健康委员会科研课题(20201653);长沙市科技局计划项目(kq1706044)。

摘　　要：目的探讨面侧区恶性肿瘤术后缺损的分类及修复重建策略。方法回顾性分析2015年1月至2018年1月湖南省肿瘤医院头颈外科收治,进行了面侧区相关肿瘤切除术后复杂创面修复的18例患者的病例资料,其中男性14例,女性4例,年龄32~68岁。根据有无骨性支架(上、下颌骨区段性)的缺失,将复杂缺损创面分为2类,面侧区软组织洞穿性缺损(5例)和面侧区软组织缺损合并骨性支撑缺损(13例)。皮瓣选择方面前者均采用游离股前外侧皮瓣修复;后者选择游离腓骨肌皮瓣(3例)、游离腓骨肌皮瓣联合游离股前外侧皮瓣(6例)和嵌合髂骨的游离旋髂深动脉穿支皮瓣联合股前外侧皮瓣(4例)修复。结果所有病例的修复皮瓣均存活。2例患者术后发生口底瘘,换药后伤口二期愈合。所有患者恢复经口进食。术后1年随访评估,达到面容对称面侧术区饱满者14例,张口度达3横指者10例。随访36~50个月,6例患者死亡,总体3年生存率66.7%。结论面侧区肿瘤术后以有无骨性支架缺失进行创面分类有利于整体修复设计,恢复面部轮廓支架,有效充填死腔,保持残留咬合关系。骨瓣联合软组织瓣的多瓣联合修复能获得良好的功能和外形修复效果。Objective To explore the classification and reconstruction strategy of defects in lateral face region after operation of malignant tumors.Methods Eighteen cases with the reconstruction of complicated defects after resection of tumors in the region of lateral face from January 2015 to January 2018 in Hunan Cancer Hospital were retrospectively reviewed.There were 14 males and 4 females,aged from 32 to 68 years.According to the presence or absence of bony scaffold,complicated defects were divided into two main categories:soft tissue perforating defects and soft tissue defects combined with bony scaffold defects.All soft tissue perforating defects in 5 cases were repaired with free anterolateral femoral flaps.Among 13 cases with soft tissue plus bony scaffold defects,3 were repaired with free fibular flaps,6 with free fibular flaps combined with free anterolateral femoral flaps,and 4 with chimeric deep circumflex iliac artery perforator flaps combined with anterolateral femoral flaps.Results All flaps survived well.Two patients complicated with fistula in floor of mouth,but the wound healed after dressing change.Transoral feeding was resumed within 2 weeks after surgery in all patients.One year follow-up evaluation showed that 14 cases had symmetrical face and 10 cases had mouth opening more than 3 transverse fingers.After 36-50 months of follow-up,6 patients died,with an overall 3-year survival rate of 66.7%.Conclusion The classification of defects with or without bony stent loss is conducive to the overall repair design,the recovery of facial contour stent,the effective fill of dead space and the maintain of residual occlusal relationship.Good reconstruction results require a multi flap combination of osteocutaneous and soft tissue flaps.

关 键 词：修复外科手术 面侧区 缺损 游离皮瓣 

分 类 号：R739.8[医药卫生—肿瘤]