携血管化阔筋膜的股前外侧皮瓣动力性修复下唇大型缺损  

Repairing large lower lip defects using the anterolateral thigh flap with vascularized fascia lata

作　　者：徐万林 卢浩 吴一凡[1] 朱云[1] 刘胜文[1] 张陈平[1] 杨雯君[1] Xu Wanlin;Lu Hao;Wu Yifan;Zhu Yun;Liu Shengwen;Zhang Chenping;Yang Wenjun(Department of Oral and Maxillofacial-Head and Neck Oncology,Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine,College of Stomatology,Shanghai Jiao Tong University National Center for Stomatology,National Clinical Research Center for Oral Diseases,Shanghai Key Laboratory of Stomatology,Shanghai 200011,China)

机构地区：[1]上海交通大学医学院附属第九人民医院口腔颌面-头颈肿瘤科,上海交通大学口腔医学院,国家口腔医学中心,国家口腔疾病临床医学研究中心,上海市口腔医学重点实验室,上海200011

出　　处：《中华整形外科杂志》2022年第1期52-57,共6页Chinese Journal of Plastic Surgery

基　　金：上海交通大学医学院附属第九人民医院生物样本库项目(YBKB201920)。

摘　　要：目的探讨应用携血管化阔筋膜的股前外侧皮瓣修复下唇大型复杂缺损的临床效果。方法回顾性分析2013年1月至2020年6月,上海交通大学医学院附属第九人民医院口腔颌面-头颈肿瘤科同一课题组应用携血管化阔筋膜的股前外侧皮瓣修复的下唇大型复杂缺损患者的临床资料。股前外侧皮瓣用于恢复缺损的组织,重建下唇外形,阔筋膜与余留的口轮匝肌形成"闭环"结构进行动力性重建。术后每2~3个月随访1次,观察皮瓣存活情况、唇部外形、张闭口及饮水等情况。结果共纳入4例患者,均为男性,年龄26~63岁,2例为下颌骨鳞状细胞癌侵犯下唇,1例为下唇动静脉畸形栓塞术后,1例为下唇鳞状细胞癌。4例患者均顺利完成下唇的修复重建,移植皮瓣面积18 cm×7 cm~26 cm×8 cm,两端携带(5~8)cm×1 cm的阔筋膜,皮瓣均全部存活。术后随访时间6~80个月,患者下唇外形良好,张口度2~3横指,闭口时能完全密封,饮水达到基本不漏水。结论携血管化阔筋膜的股前外侧皮瓣可对下唇大型复杂缺损进行外形修复及动力性重建,能达到较好的临床效果。Objective To explore the application of the the anterolateral thigh flap(ALTF)with vascularized fascia lata in repairing large lower lip defects.Methods From January 2013 to June 2020,the clinical data of the cases with large complex lower lip defect due to extensive resection of lip tumor treated in the Department of Oral and Maxillofacial-Head and Neck Oncology,Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine were analyzed retrospectively.The patients were immediately reconstructed using ALTF with vascularized fascia lata.The flap was used for shape reconstruction,and the fascia lata with residual orbicularis muscle was used for functional reconstruction via simulating the"closed-loop structure"of orbicularis.All these patients were followed up by regular visit.The survival of flap,mouth opening and closing were recorded.Results All the 4 patients were successfully repaired through the above methods.The ALTF area was 18 cm×7 cm-26 cm×8 cm,with(5-8)cm×1 cm fascia lata at both sides of the flap.The survival rate of ALTF was 100%.After 6-80 months’follow-up,the ALTF was in good shape,and the mouth opening degree was 2-3 fingers.When the mouth was closed,the upper and lower lip could be sealed completely,and the drinking water is basically watertight.Conclusions The shape and dynamic reconstruction could be completed in large complex lower lip defects through ALTF with vascularized fascia lata.The clinical effects were satisfying,and it’s an ideal option for repairing large complex lower lip defects.

关 键 词：外科皮瓣 大型唇缺损 股前外侧皮瓣 阔筋膜 动力性重建 

分 类 号：R782.2[医药卫生—口腔医学]