头颈部肿瘤术后缺损游离组织瓣的供区选择

DONOR SITE CHOICE FOR FREE FLAPS IN HEAD AND NECK RECONSTRUCTION AFTER TUMOR SURGRY

目的应用游离组织瓣修复头颈部肿瘤术后缺损,探讨较简便合适的方法。方法回顾并分析1999年1月~2002年1月,采用游离组织瓣修复头颈部肿瘤术后缺损86例。缺损部位:口腔32例,下咽27例,下颌骨12例,颅底5例,中面部4例和头皮/皮肤6例。供区:腹直肌皮瓣32例,股前外侧皮瓣10例,空肠瓣25例,腓骨瓣11例,背阔肌皮瓣4例,前臂皮瓣3例和肩胛皮瓣1例。其中皮瓣或肌皮瓣大小4 cm×5 cm^14 cm×24 cm,腓骨瓣长度4~16 cm,空肠瓣长度9~20 cm。结果游离组织瓣术后成活79例,成活率为92%。其中口腔缺损采用腹直肌肌皮瓣22例(69%)和股前外侧皮瓣10例(31%)修复;下咽缺损主要用空肠瓣修复25例(93%),下颌骨缺损则用腓骨瓣修复11例(92%),颅底缺损由腹直肌皮瓣修复4例(80%)。腹直肌、股前外侧、空肠和腓骨4种组织瓣修复头颈部缺损78例,占同期游离组织瓣的91%。结论头颈部肿瘤术后缺损复杂,利用腹直肌肌皮瓣、股前外侧皮瓣、空肠瓣和腓骨瓣可解决大多数修复重建的难题。

Objective To choose suitable free flaps for reconstructing head and neck defects caused by tumor resection. Methods A retrospective analyses was made in 86 cases of head and neck defects treated with four kinds of free flaps between January 1999 and January 2002. The head and neck defects were caused by tumor resection. The locations were oral cavity （n=32）, hypopharynx （n=27）, mandible （n=12）, skull base （n=5）, scalp and skin （n=6） and midface（n=4）. The donor sites of free flaps included the rectus abdominis （n=32）, anterolateral thigh （n=10）, jejunum （n=25）, fibula （n=11）, latissimus dorsi （n=4）, forearm （n=3）and scapula （n=1）. The sizes of the cutaneous/musculocutaneous flaps ranged from 4 cm× 5 cm to 14 cm× 24 cm. The lengths of the fibula were 4-16 cm, of jejunum 9-20 cm. Results The overall free flap success rate was 92% （79/86）. Of 32 oral cavity defects, 22 were reconstructed by rectus abdominis （69%） and 10 by anterolateral thigh flaps （31 % ）. Of 27 hypopharyngeal defects, 25 were restored by jejunum flaps （93%）. Eleven of 12 mandibular defects were reconstructed by fibula flaps（92% ）. Four of 5 defects of skull base were reconstructed by rectus abodominis flaps （80%）. The free flaps of rectus abodominis, anterolateral thigh, jejunum and fibula were most frequently used, accounting for 91% （78/86） of all flaps in head and neck defect reconstruction. Conclusion Although head and neck defects represent a complicated spectrum of subsites and loss, these four free flaps can manage most reconstruction problems.