游离股前外侧穿支皮瓣修复头颈颌面部恶性肿瘤切除术后缺损的临床疗效分析  

Clinical efficacy analysis of free anterolateral femoral perforator flap in repair of head,neck and maxillofacial tumors after resection of malignant tumors

作　　者：张宏[1] 王军[1] 范向达[1] 张建伟[1] 王娟[1] Zhang Hong;Wang Jun;Fang Xiangda;Zhang Jiangwei;Wang Juan(Gansu Cancer Hospital,Lanzhou,Gansu,730050,China)

机构地区：[1]甘肃省肿瘤医院,甘肃兰州730050

出　　处：《中国医学文摘（耳鼻咽喉科学）》2022年第5期52-57,F0002,共7页Chinese Medical Digest(Otorhinolaryngology)

摘　　要：目的探讨游离股前外侧穿支皮瓣在头颈颌面部恶性肿瘤根治术后缺损的修复重建中的应用价值及临床效果,以期为临床提供经验。方法收集自2019年1月—2021年12月在甘肃省肿瘤医院头颈外科应用游离股前外侧穿支皮瓣修复头颈口腔颌面部恶性肿瘤扩大切除术后的复杂缺损12例,通过分析游离股前外侧穿支皮瓣制备技术、皮瓣成活率、术后并发症的发生情况、受区外形及功能恢复、供区的并发症进行总结分析,为初学游离股前外侧皮瓣进行头颈颌面部缺损修复的医生提供技术支持。结果所有皮瓣均存活,术后均未发生血管危象,其中术后1例口颊癌患者因腮腺瘘出现受区皮瓣下积液,经穿刺抽液、换药后伤口愈合。术后1例出现大腿根部淋巴瘘,经大腿根部加压包扎后愈合,无感染并发症出现。大腿部供区伤口仅留下线性瘢痕,随访3~24个月,患者对面部外形及功能恢复满意。12例游离股前外侧穿支皮瓣均成活,皮瓣成活率100%,皮瓣的尺寸大小3.5cm×10.0cm~32.0cm×11.0cm。术前均用彩色多普勒超声进行穿支定位,共定位31支,平均每条腿2-3支,术中发现24支(77.4%)定位准确,术中观察穿支类型为肌间隔穿支的4例,(33.3%),肌皮穿支的8例(66.7%),血管来源为降支10例(83.3%),横支的1例(8.3%),斜支1例(8.3%)。其中制成一蒂多岛的嵌合皮瓣1例,为口颊癌患者,皮瓣分别修复口内口外,肌瓣填塞腮腺区及颅底,病理诊断主要为鳞状细胞癌10例,1例为面部基底细胞癌、1例为硬腭腺样囊性癌。供区术后均一期缝合,无明显长期并发症。结论游离股前外侧穿支皮瓣可用于修复头颈颌面部恶性肿瘤扩大切除术后留下的各种缺损,能有效地预防和减少术后并发症的发生,值得在临床中大力推广。Objective To explore the application value and clinical effect of free anterolateral femoral perforator flap in the repair and reconstruction of defects after radical resection of head,neck and maxillofacial tumors,in order to provide clinical experience.Methods Collected from January 2019 to December 2021 in the Department of Head and Neck Surgery,Gansu Cancer Hospital,using free anterolateral femoral perforator flap to repair complex defects after extended resection of head and neck oral and maxillofacial tumors.The preparation technique of the anterolateral femoral perforator flap,flap survival rate,the occurrence of postoperative complications,the shape and function recovery of the recipient site,and the complications of the donor site were summarized and analyzed.Facial defect repair doctors provide technical support.Results All flaps survived,and no vascular crisis occurred after operation.One patient with oral and buccal carcinoma had fluid accumulation under the recipient flap due to parotid fistula after operation.The wound healed after puncture extraction and dressing change.One case developed a lymphatic fistula at the root of the thigh after surgery,which healed after compression and bandage of the root of the thigh,and no infection complications occurred.The wounds at the donor site of the thigh only left linear scars.The patients were followed up for 3 to 24 months,and the patients were satisfied with the recovery of facial appearance and function.All 12 free anterolateral thigh perforator flaps survived,and the flap survival rate was 100%.The size of the flaps ranged from 3.5cm×10.0cm to 32.0cm×11.0cm.Color Doppler ultrasound was used to locate the perforators before operation.A total of 31 branches were located,with an average of 2-3 branches per leg.During the operation,24 branches(77.4%)were found to be accurate in localization.4 cases(33.3%),musculocutaneous perforators in 8 cases(66.7%),descending branches in 10 cases(83.3%),transverse branches in 1 case(8.3%),and oblique branches in 1 case(

关 键 词：游离股前外侧穿支皮瓣 头颈颌面部缺损 组织缺损 修复重建 

分 类 号：R73[医药卫生—肿瘤]