穿支游离皮瓣修复头颈肿瘤术后缺损

Free perforator flaps in head and neck reconstruction

目的 探索更为理想的穿支游离皮瓣修复技术，运用于头颈肿瘤术后缺损。方法 2003年12月-2005年5月用于头颈部手术缺损修复的穿支游离皮瓣共14例（股前外侧皮瓣8例，腹壁下深动脉穿支皮瓣6例）。其中10例为复发后挽救手术，12例曾行放疗（平均63．5Gy）。头颈部肿瘤手术缺损部位分别为舌体3例，颊黏膜3例，口咽壁3例，舌根2例，颅底、头皮以及中面部各1例。受区供吻合动脉主要是甲状腺上动脉和面动脉；静脉为颈内静脉。结果 13例穿支游离皮瓣成功（93％），有1例穿支皮瓣因吻合侧的颈内静脉血栓形成导致皮瓣坏死。受区未发现其它明显并发症。供区均直接缝合关闭并一期愈合，未发现腹壁疝和运动受限等手术并发症。结论 穿支游离皮瓣保留了供区的肌肉、筋膜和神经，将供区的并发症降到最低限度，是头颈部缺损修复新的可靠技术。

Objective The advantage of perforator flaps versus musculocutaneous flaps is the reduced morbidity of the donor site with preservation of the nerves, muscles and deep fascia. We evaluate the reconstruction result of perforator flaps in head and neck region. Methods A retrospective review was performed of perforator flap reconstructions for head and neck tumor ablation defects since December of 2003 to May of 2005. There were 14 flaps including 8 anterolateral thigh （ALT） flaps and 6 deep inferior epigastric artery perforator （DIEAP） flaps. Recipient sites were subdivide into oral tongue （ n=3 ）, buccal mucosa （ n = 3 ）, pharyngeal wall （n = 3） , base of tongue （n = 2）, skull base （n = 1）, scalp （n=1） and midface（n = 1）. Results The overall free flap success rate was 93% （ 13/14）. One DIEAP flap lost because the draining jugular vein was thrombosed. No complications were observed in the donor site, including wound dehiscence, weakness and hernia. Conclusion Perforator flaps are the new and reliable technique for head and neck surgical defects. Because of the minimum donor site morbidity, the perforator flap may be one of the primary choice in the near future.