游离上臂外侧皮瓣修复舌癌术后软组织缺损的临床应用  

Clinical application of lateral arm free flap in tissue deflect reconstruction after tongue cancer surgery

作　　者：崔捷 陈杰 黄文孝 魏明辉 朱伟谕 梁龙飞 钟外生 CUI Jie;CHEN Jie;HUANG Wenxiao;WEI Minghui;ZHU Weiyu;LIANG longfei;ZHONG Waisheng(Department of Head and Neck Surgery,National Cancer Center,National Clinical Research Center for Cancer,Cancer Hospital and Shenzhen Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Shenzhen 518000,China;Department of Head and Neck Surgery,Hunan Cancer Hospital,the Affiliated Cancer Hospital of Xiangya School of Medicine,Central South University,Changsha 410013,China)

机构地区：[1]国家癌症中心、国家肿瘤临床医学研究中心、中国医学科学院北京协和医学院肿瘤医院深圳医院头颈外科,广东深圳518000 [2]湖南省肿瘤医院、中南大学湘雅医学院附属肿瘤医院头颈外科,湖南长沙410013

出　　处：《中国耳鼻咽喉颅底外科杂志》2023年第5期14-18,共5页Chinese Journal of Otorhinolaryngology-skull Base Surgery

基　　金：深圳市“医疗卫生三名工程”项目资助(SZSM201911006)。

摘　　要：目的探讨游离上臂外侧皮瓣一期修复舌癌术后软组织缺损的临床应用。方法选取2019年6月-2021年9月舌癌根治术的32例患者,应用游离上臂外侧皮瓣同期行舌缺损修复。其中男25例,女7例,病理类型均为鳞状细胞癌。术前多普勒血流探测仪确定上臂外侧区域穿支血管位置,皮瓣轴线位于三角肌止点与肱骨外上髁之间的连线后方1 cm,根据舌缺损面积和形状设计皮瓣。结果32例患者中,皮瓣大小为7.5 cm×4.0 cm~14.0 cm×6.0 cm,平均厚度为(0.85±0.40)cm,平均血管蒂长度为(8.24±1.37)cm,穿支数量为2~4支。供区切口均一期拉拢缝合。除1例患者术后第4天皮瓣坏死改股前外侧皮瓣修复后皮瓣存活,皮瓣一期成活率为96.9%(31/32)。所有患者术后均未行气管切开。随访7~22个月,平均11个月,患者术后外形及功能恢复较满意,无远期并发症。结论游离上臂外侧皮瓣血管恒定、制备简单、质地薄软,皮瓣成活率高,供区并发症少,是修复舌癌术后半舌缺损的良好选择。Objective To explore the clinical application of lateral arm free flap in one-stage repair of soft tissue deflect after radical resection of tongue cancer.Methods From June 2019 to September 2021,a total of 32 patients received treatment of lateral arm free flap for one-stage repair of soft tissue defect after tongue cancer radical surgery.Of them,25 cases were male,7 were female.As for the pathology,all cases were squamous cell carcinoma.Preoperatively,the perforating vessels in the lateral arm region were positioned by Doppler blood flow detector,and the flap axis was located at 1 cm behind the line between the insertion of the deltoid and the external epicondyle of the humerus.The flaps were designed based on the sizes and shapes of the tongue defects.Results In this group of the 32 patients,the intraoperative flap area size ranged from 7.5 cm×4.0 cm to 14.0 cm×6.0 cm with flap thickness of(0.85±0.40)cm and pedicle length of(8.24±1.37)cm.The median number of perforator was 3(ranged from 2 to 4).All donor sites of these cases were closed primarily.Flap necrosis occurred on the fourth day after operation in one patient,and was successfully salvaged with a redesigned anterolateral thigh flap.The overall flap survival rate was 96.9%(31/32).No patient received tracheotomy.The postoperative follow-up with a mean period of 11 mouths(ranged from 7 to 22 mouths)revealed no obvious long-term complications,and all patients were satisfied with the shape and function of the flaps.Conclusion With advantages of consistency of perforators,thin and soft texture,simple harvest method,high survival rate and low donor site complications,the lateral arm free flap is suitable to reconstruct tongue with half deflect for tongue cancer patients.

关 键 词：舌癌 鳞状细胞癌 游离上臂外侧皮瓣 修复 组织缺损 

分 类 号：R739.86[医药卫生—肿瘤]