改良前臂皮瓣在舌和口底联合缺损修复中的应用

Modified free forearm flap for tongue and oral floor reconstruction

目的:介绍改良游离前臂皮瓣在舌、口底缺损修复中的应用效果。方法:应用改良前臂皮瓣同期游离移植修复因舌癌行扩大根治切除术后的舌、底联合缺损13例,术中根据舌、口底和牙槽骨缺损的大小设计、制备、利用改良前臂皮瓣;术中常规掀起前臂皮瓣皮岛,并保留血管蒂周围蜂窝结缔组织,形成包绕桡动静脉、头静脉的蜂窝结缔组织袖,游离移植于口内,吻合血管,再造舌并修复口底缺损。结果:前臂皮瓣全部成活,患侧颌面形态和舌外形恢复满意,舌动度较好,语音较清晰。结论:改良前臂皮瓣具有血管恒定,切取制备容易,组织量较丰富,具有较广的适应证,是同期修复舌癌术后舌和口底联合缺损的比较满意的方法,值得推广应用。

Objective The purpose of this study is to introduce the clinic experience of using modified free forearm flap for tongue and oral floor reconstruction. Methods The technique for harvesting the skin paddle of modified free forearm flap was as same as the traditional forearm flap. But the subcutaneous tissue cuff was around the vital vessels of modified free forearm flap including radial artery,radial vein and cephalic vein. Modified free forearm flap was used in 13 patients with tongue and oral floor defect resulting from radical excision of carcinoma of tongue. According to the size of the defects, the modified free forearm flaps with subcutaneous tissue cuff around the vital vessels were designed, harvested and transferred into oral cavity by vascular anastomosis technique to reconstruct tongue and oral floor. Results The overall flap survival rate was 100%（all of 13 cases）.The appearance of the tongue, the speaking and swallowing functions were well recovered.The satisfactory result was achieved in 13 patients. Conclusion The modified free forearm flap showed many advantages： stable blood supply,flap thickness was suitable for tongue reconstruction,and abundant soft tissue was provided for oral floor reconstruction. It is an ideal approach for tongue and oral floor defects.