横向颈阔肌肌皮瓣和面动脉-颏下动脉岛状肌皮瓣修复颊黏膜癌术后缺损

Transverse platysma myocutaneous flap and facial artery-submental artery island myocutaneous flap for reconstruction of buccal defects following cancer surgery

目的:评价横向颈阔肌肌皮瓣和面动脉-颏下动脉岛状肌皮瓣修复颊黏膜癌术后缺损的可靠性。方法:27例颊黏膜鳞状细胞癌手术切除后组织缺损,用颈阔肌肌皮瓣修复15例,面动脉-颏下动脉岛状肌皮瓣修复12例。男19例,女8例;年龄38～74岁,平均56.4岁;T1N0M0期6例,T2N0M0期19例,T3N0M0期2例。皮瓣大小为4.0cm×8.0 cm～5.0cm×11.0 cm。结果:颈阔肌肌皮瓣存活13例,3例小部分坏死,成功率为86.7%(13/15),面动脉-颏下动脉岛状肌皮瓣成功率为91.7%(11/12)。全部病例经6～24个月复查,受区功能正常,供区外形良好。局部复发1例,颈部复发2例。结论:颈阔肌肌皮瓣和面动脉-颏下动脉岛状肌皮瓣均适于颊黏膜中、小型缺损修复。面动脉-颏下动脉岛状肌皮瓣可能比颈阔肌肌皮瓣更为可靠。

PURPOSE： To assess the reliability and usefulness of transverse platysma myocutaneous flaps and facial artery-submental artery island myocutaneous flaps for reconstruction of buccal mucosal defects following cancer surgery. METHODS： Twenty-seven buccal mucosal defects were repaired with transverse platysma myocutaneous flaps （n=15） and facial artery-submental artery island myocutaneous flaps （n=12） after resection of the buccal mucosa squamous cell carcinoma. Among them, 19 patients were males and 8 patients were females; the ages of the patients ranged from 38 to 74 years （56.4 years on average）. Six patients were classified as 6 T1N0M0, 19 as T2N0M0, and 2 as T3N0M0. The sizes of the skin paddle ranged from 4.0 cm×8.0 cm to 5.0 cm×11.0 cm. RESULTS： The postoperative outcome for the platysma myocutaneous flaps was survival in 13 cases, including 3 cases with minimal partial necrosis, the success rate was 86.7% （13/15）. The success rate of the facial artery-submental artery island myocutaneous flaps was 91.7% （11/12）. The appearance and function of the recipient sites were well recovered. All the patients were followed up for 6-24 months （16 months on average）, local recurrences were found in 1 case and cervical recurrence in 2 cases. CONCLUSIONS： The platysma myocutaneous flap and the facial artery-submental artery island myocutaneous flaps are suitable to repair small and medium-sized buccal mucosal defects. It seems that the facial artery-submental artery island myocutaneous flaps is more reliable than the platysma myocutaneous flap.