颏下岛状皮瓣在下咽癌术后缺损修复中的临床应用——单中心经验分享  

Clinical application of submental island flap in repairing the postoperative defect of hypopharyngeal carcinoma:Single centre experience

作　　者：李平栋[1] 李海洋[2] 丁硕 周晶[1] 陈晓红[1] LI Pingdong;LI Haiyang;DING Shuo;ZHOU Jing;CHEN Xiaohong(Department of Otolaryngology,Head and Neck Surgery,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China;Department of Otolaryngology,People’s Hospital of Beijing Daxing District,Beijing 102600,China)

机构地区：[1]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科,北京市100730 [2]北京市大兴区人民医院耳鼻咽喉科,北京市102600

出　　处：《组织工程与重建外科》2023年第2期130-134,共5页Journal of Tissue Engineering and Reconstructive Surgery

摘　　要：目的回顾分析颏下岛状皮瓣在下咽癌术后缺损修复和功能重建中的应用,并结合新鲜灌注尸体解剖,从皮瓣解剖设计、临床应用及修复效果进行单中心的经验总结。方法本研究进行了3具新鲜灌注的成人尸体(6侧颏下岛状皮瓣区)的解剖分析,并分析了13例下咽癌切除术后一期颏下岛状皮瓣修复患者,均为男性,平均年龄55岁。术后缺损部位包括梨状窝和下咽后壁。详细介绍颏下岛状皮瓣皮瓣制作的术中解剖要点及技术,血管蒂的保护及颌下区淋巴结的处理。结果所有13例患者皮瓣均一期愈合,下咽功能重建满意,供皮区的并发症主要是面神经下颌缘支的一过性麻痹(3/13,23%),供皮区均一期局部拉拢缝合,无须植皮。结论颏下岛状皮瓣是下咽术后缺损的很好的修复选择之一。该皮瓣血管蒂恒定,成活率高。皮瓣获取与下咽癌手术在同一术区,切取方便,同时还可以兼顾Ⅰ区淋巴结的处理。Objective To review the clinical application of submental island flap(SIF)in repairing the postoperative defect of hypopharyngeal carcinoma,and discuss the anatomical design,clinical application and repair effects based on our single center experience combined with fresh perfusion cadavers study.Methods The anatomical analysis of 6 SIFs in 3 freshly perfused adult cadavers was firstly carried out.Combined with clinical experience,13 patients with submental island flap repair after hypopharyngeal cancer resection were reviewed,all of them were male,with an average age of 55 years.Postoperative defects included piriform fossa and posterior hypopharyngeal wall.The anatomical essentials and techniques of SIFs,the protection of vascular pedicle and the management of submandibular lymph nodes were described in detail.Results All 13 SIFs were healed primarily.The hypopharyngeal functions were satisfied.The main complication of the donor site was transient paralysis of the marginal mandibular branch of the facial nerve(3/13,23%).The donor site was primarily closed without skin grafting.Conclusion SIF may be an appropriate option for repairing hypopharyngeal defects.The vascular pedicle of the flap is constant and the survival rate is high.The skin flap can be obtained in the same surgical area as the hypopharyngeal cancer surgery,which is convenient to harvest,and it can also take into account the management of lymph nodes in LevelⅠ.

关 键 词：颏下动脉 岛状皮瓣 下咽癌 

分 类 号：R628[医药卫生—整形外科]