小腿内侧皮瓣在口腔颌面部术后缺损修复中的应用

Use of the lower medial leg fasciocutaneous flap to reconstruct oral and maxillofacial soft tissue defects

目的:评价小腿内侧皮瓣在口腔颌面软组织缺损修复中的价值。方法:对2例累及舌腹部及下颌舌侧骨板的口底鳞癌,行原发灶根治术及保留颏部下缘的颏部截除术;4例舌癌均行原发灶根治术,术中保留下颌舌侧牙龈,未行下颌骨骨段切除术;2例颊部鳞癌患者行保留下颌骨下缘的原发灶根治术;8例患者均行颈淋巴清扫术,术中解剖出面动脉、颈外静脉和颈前静脉,再根据口腔缺损的范围制备相应大小及形状的皮瓣,皮瓣以胫后动、静脉为蒂。将皮瓣的胫后动脉与面动脉吻合,将皮瓣的胫后静脉与颈外静脉(或颈前静脉)吻合,然后将皮瓣与缺损区边缘严密缝合。结果:8例小腿内侧皮瓣均获得成功,口内、外伤口愈合良好,修复效果良好,覆盖于小腿内侧皮肤缺损区的皮片全部成活。结论:小腿内侧皮瓣适用于舌、口底、颊部及面颈部软组织缺损的修复。口腔颌面部肿瘤术后软组织缺损,可利用携带部分比目鱼肌的小腿内侧皮瓣进行修复。

PURPOSE： To investigate and evaluate the role of lower medial leg fasciocutaneous flap in reconstruction of oral and maxillofacial soft tissue defects. METHORDS： Two cases of squamous cell carcinoma （SCC）in the floor of mouth with involvement of the ventral tongue and inner plate of the mandible underwent radical resection of the primary lesions and osteotomy of the chin with preservation of the lower border. Radical resection was also applied on 4 cases of tongue SCC, the lingual gingiva being preserved without segmental mandibulectomy; The lower border of the mandible was preserved in 2 cases of buccal SCC; All 8 cases underwent radical neck dissection, the facial artery, external cervical or anterior cervical vein were prepared during operation.The lower medial leg fasciocutaneous flap pedicled on the posterior tibial artery and vein was harvested according to the size and shape of the defects.The posterior tibial artery and vein were anastomose to the facial artery, external cervical or anterior cervical vein, respectively. RESULTS： All the 8 flaps survived well postoperatively. The results of reconstruction was satisfactory in terms of esthetics and function. The free skin grafts on the donor site survived well, too. CONCLUSIONS： The lower medial leg fasciocutaneous flap is a good material for reconstruction of defects in oral and maxillofacial region.Soft tissue defects caused by tumor ablation can be reconstructed with lower medial leg myocutaneous flap accompanied with partial flatfish muscle.