股前外侧皮瓣和前臂皮瓣在头颈部组织缺损修复中的比较

Comparison of anterolateral thigh flap and forearm flap in repair of head and neck defects

目的报道股前外侧皮瓣和前臂皮瓣在头颈部缺损修复中的临床效果和优缺点。方法分别采用前臂皮瓣和股前外侧皮瓣修复头颈部缺损32例。其中应用前臂皮瓣20例，修复口颊部洞穿性缺损7例、环下咽缺损4例、上腭缺损2例、腮腺区皮肤缺损1例、口底缺损4例，舌根部缺损2例，股前外侧皮瓣12例，分别用于修复舌根部缺损3例，上腭缺损4例，口底、下牙龈缺损5例。对比两组的皮瓣存活情况、修复后功能状况和对供区的影响，分析其优缺点和技术要点。结果前臂皮瓣完全存活19例，发生血管危象2例，1例经保守治疗后完全存活，1例再次手术后皮瓣表皮坏死。股前外侧皮瓣12例均完全存活，无血管危象发生。原计划行股前外侧皮瓣修复术14例中有2例因皮瓣制备失败而放弃并改用前臂皮瓣。股前外侧继发缺损均可直接拉拢缝合，前臂继发缺损均需植皮。结论股前外侧皮瓣和前臂皮瓣移植均有较高成功率，但各有优缺点，修复手段的选择宜根据缺损情况和修复目的灵活使用。

Objective To report the clinical results and the advantages/disadvantages of anterolateral thigh flap （ALT） and forearm flap （FAF） in reconstruction of head and neck defect after cancer ablation. Methods 20 FAFs and 12 ALTs were performed to repair the head and neck tumor ablation defects. Of the 20 FAFs, 7 were used for repair of the through and through buccal defects, 4 for circumferential hypopharyngeal defects, 2 for plate defects, 1 for parotid area skin defect, 4 for floor of the mouth defects, and 2 for defect, of the base of the tongue, while of the 12 ALTs, 3 were used for repair of the defects of the base of the tongue, 4 for plate defects, and 5 for the floor of the mouth and/or lower gum defects. Survival of the flaps, function of the recipient site, and impact to the donor site were compared between these two groups to analyze the advantages/disadvantages and key technique details of these two flaps. Results 19 FAFs totally survived. Vascular crisis occurred in 2 cases of FAF, of which l flap survived after conservative treatment, while the other 1 developed partial necrosis. All the 12 ALTs survived, without vascular crisis. 2 of the 14 planed ALTs were abandoned and replaced by FAFs, of which 1 because of absence of the perforating branch and the other 1 because of injury of the perforating branch. Secondary defects of the ALTs could be closed primarily, while secondary defects of the FAFs should be closed with skin grafts. Conlusion Both ALT and FAF can be performed with high survival rate. Each has its own advantages. Selection of the donor site depends on situation of the defect and purpose of the reconstruction.