股前外侧游离筋膜瓣在口咽部缺损修复重建中的应用  

Application of anterior-lateral thigh fasia lata free flaps in reconstruction of oropharyngeal defect

作　　者：肖芒[1] 叶荆 姜晓华[1] 郑倩倩 XIAO Mang;YE Jing;JIANG Xiaohua(Department of Otolaryngology Head and Neck Surgery,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Hangzhou 310016,China)

机构地区：[1]浙江大学医学院附属邵逸夫医院耳鼻咽喉头颈外科,浙江杭州310016

出　　处：《全科医学临床与教育》2022年第12期1066-1068,1096,F0003,共5页Clinical Education of General Practice

基　　金：国家自然科学基金(62071415)。

摘　　要：目的探讨股前外侧游离筋膜瓣在口咽部缺损修复重建中的应用价值。方法选取15例应用股前外侧游离筋膜瓣修复口咽软组织缺损的口咽恶性肿瘤患者病历资料进行回顾性分析。术后观察随访6个月~2年,对皮瓣的颜色、质地、面部外形及功能恢复、供区的畸形及并发症进行综合分析及评价。结果股前外侧游离筋膜瓣质地薄而柔软,无需修薄皮瓣。术后所有皮瓣均完全成活,无血管危象发生。3例患者腿部供区引流管拔管后再发积液。术后2周内皮瓣表面均显凹凸不平现象。术后1个月时,皮瓣逐渐上皮化。所有患者的口咽部异物感均在承受范围内,术后1年吻合处完全上皮化,除外2例复发转移患者,供区无1例出现粘连或挛缩导致的功能障碍,供区瘢痕不明显。结论股前外侧游离筋膜瓣是口咽恶性肿瘤术后组织缺损的理想皮瓣。由于不需要供区皮肤,创面可直接拉拢缝合,受区由于是筋膜与黏膜缝合,不需要非常严密的吻合即可保证修复的疗效。Objective To evaluate the effectiveness of anterior-lateral thigh fasia lata free flaps in the reconstruction of oropharyngeal soft tissue defects after oropharyngeal malignant tumor resection.Methods A retrospective study on 15 cases with oropharyngeal soft tissue defects restored with anterior-lateral thigh fasia lata free flaps was perfomed.The appearance and function of the faciocervical organs and donor site complications and morbidities were evaluated after 6-24 months’follow-up.Results The anterolateral femoral free fascia flap was thin and soft,and no flap was needed.All flaps survived completely without vascular crisis.Three patients had recurrent effusion after extubation of the drainage tube at the donor site.All flaps showed irregularity within 2 weeks after operation.At 1 month after surgery,the flap was gradually epithelialized.All patients were within the tolerance range of foreign body sensation in the oropharynx.At 1 year after operation,the anastomosis was completely epithelialized.Except for 2 patients with recurrence and metastasis,there was no dysfunction caused by adhesion or contracture at the donor site,and the scar at the donor site was not obvious.Conclusion It is an ideal flap for soft tissue defect after oropharyngeal malignant tumor resection.Since no skin of the donor site were sacrificed,the wound can be directly closed and sutured without strong tension.Furthermore,the suture between fascia of donor site and mucosa of recipient site did not require strong tightness.

关 键 词：股前外侧游离筋膜瓣 口咽恶性肿瘤 口咽部缺损 显微外科 

分 类 号：R739.8[医药卫生—肿瘤]