带肋胸膜的肋骨-胸大肌复合瓣修复晚期舌癌根治术后缺损

Combined repair of large defect caused by radical surgery of advanced tongue cancer with rib-major pectoralis myocutaneous flap carrying costal parietal pleura

目的探讨应用带肋胸膜的肋骨-胸大肌复合瓣联合修复晚期舌癌根治术后软硬组织大型缺损的临床效果和安全性。方法对6例累及同侧口底和下颌骨并越过中线的晚期舌癌患者实施舌颌颈联合根治术,开胸切取以胸肩峰动静脉为血管蒂的带肋胸膜的肋骨(第5肋)-胸大肌复合瓣即刻修复根治术导致的全舌、口底和下颌骨大型复合组织缺损,其中胸大肌肌皮瓣用以重建全舌和口底,肋骨瓣则用以修复患侧下颌骨。结果6例患者术后恢复良好。肋骨-胸大肌复合瓣全部成活,术后口腔、颈部和胸部创面均一期愈合。重建全舌、口底和面下部形态良好,上下颌咬合关系正常,下颌骨无偏斜,语言和吞咽功能基本恢复正常。结论带肋胸膜的肋骨-胸大肌复合瓣修复口腔颌面大型软硬组织缺损安全可靠,开胸切取肋胸膜不会导致患者术后胸廓运动和呼吸功能异常及其他胸肺部并发症,而且制备简便,带肋胸膜确保了肋骨-胸大肌复合瓣中肋骨的血运。

Objective To explore the clinical value and safety of using rib-major pectoralis myocutaneous flap carrying costal parietal pleura in combined repair of large soft and hard tissue defect caused by radical surgery of advanced tongue cancer. Methods Six patients with advanced tongue carcinoma involving the floor of mouth and mandible were performed combined radical neck dissection with glossectomy and mandibulectomy, which caused large soft and hard tissue defect. Six rib-major pectoralis myocutaneous flaps carrying costal parietal pleura were transferred for immediate repair of the large defects. The rib flaps were applied for the repair of mandible, and the major pectoralis myocutaneous flaps were applied for the reconstruction of tongue and floor of mouth. Results Six patients recovered well after operation. Six rib-major pectoralis myocutaneous flaps carrying costal parietal pleura survived well; the wounds of surgical incision of the oral cavity, neck, and chest healed up. The reconstructed tongue and the lower face appearance were satisfactory, the occlusion relationships were normal; the speaking as well as swallowing functions recovered. Conclusions It＇s safe and reliable to use rib-major pectoralis myocutaneous flap carrying costal parietal pleura to repair large soft and hard tissue defect in oral and maxillofacial region. Opening pleural cavity and harvest costal parietal pleura would not influence patients＇ thoracic movement and breath function and would not cause other complications. It＇s simple and safe for harvesting the composite flap. Carrying costal parietal pleura assures the sufficient blood supply of rib in the composite flap.