股前外侧皮瓣修复口腔颌面组织缺损

Free anterolateral thigh flap for repairing the defects of oral cavity and maxillofacial

目的总结游离股前外侧皮瓣在修复口腔肿瘤切除术后组织缺损的经验和教训。方法2004年12月-2005年12月应用吻合血管的游离股前外侧皮瓣修复舌鳞癌17例,口颊鳞癌6例和其他恶性肿瘤切除术后的口腔颌面部组织缺损8例,皮瓣(4～8)cm×(6—23)cm。术中同时气管切开4例。结果皮瓣完全成活者30例,成活率96．8％。3例术后12 h～4 d出现静脉血管危象,其中1例静脉血管危象和1例静脉血栓均抢救成功,皮瓣完全成活;另1例术后因皮瓣淤血时间较长,最后皮瓣坏死约25％。30例患者无瘤生存,1例术后8个月死于颈部淋巴结复发未控。结论股前外侧皮瓣厚薄适中,是修复口腔组织缺损的良好材料。皮瓣大小应与受区缺损大小相当,避免皮瓣挤压。肿瘤手术必须在保证安全切缘的同时,尽可能保留牙齿等重要的口腔功能结构;缝合皮瓣应防止扭曲血管蒂,避免静脉受压。修复软硬腭时加行气管切开比较安全。

Objective To investigate the outcomes following the tumor resection of oral cavity and maxillofacial and reconstruction with free anterolateral thigh flaps （ALT）. Methods Thirty one patients underwent ALT reconstruction following the tumor resection from Dec. 2004 to Dec. 2005. Among them, 17 cases were squamous cell carcinoma （SCC） of tongue, 6 cases of buccal SCC and 8 other malignents. The size of the ALT flaps ranged from 4 to 8 cm in width and 6 to 23 cm in length. Tracheotomy were performed for 4 cases introperatively. Results The overall successful rate was 96. 8%. Thirty cases survival no cancer, 1 case died of recurrent and no-controled of lymph-node in 8 months after operation. Postoperative vessel thrombosis occurred in 3 flaps between 12 hours to 4 days after operation. Two of them were saved. The necrosis area of the third flap was 25%. Conclusions The ALT was benefit to repair the defects of oral cavity and maxillofacial, and the donor place was more easily hidden and didn＇t not influence the outlook and function; the important normal functional framing such as teeth and bone should be preserved; the pedicle of vessel could＇t be twisted during the procedure of reconstruction to avoid vein oppressed ; the size of flap should be suitable to defects in order to avoid flaps being crowd and blood clot ; tracheotomy was safe while repairing the defect of hard and soft palate.