应用游离股前外侧皮瓣修复头颈部软组织缺损

Application of anterolateral thigh free flap to reconstruct head and neck soft tissue defects

背景与目的:股前外侧皮瓣(ALT)对供区创伤小,有独特优点,但目前临床应用还不常见。本文探讨应用ALT皮瓣修复头颈部软组织缺损的临床价值。方法:回顾2004年11月至2008年5月期间于中山大学肿瘤防治中心20例应用ALT皮瓣修复重建头颈部软组织缺损的病例资料。总结皮瓣切取的技术细节。报告术中解剖和成功率。结果:20例游离股前外侧皮瓣修复头颈部软组织缺损均获成功。ALT皮瓣血管蒂长介于5～14cm,平均9.9cm。切取的面积介于(4～9cm)×(6～16cm)。皮肤穿支的解剖类型分为肌间隔穿支4例(占20%),肌皮穿支16例(占80%)。股前外侧皮瓣用于修复的头颈部缺损包括口腔内黏膜缺损14例(其中修复舌体及口底9例、口颊黏膜3例、硬腭1例、以及磨牙后区黏膜1例),面部及颈部皮肤缺损6例。皮瓣供区除1例以外均可一期缝合。结论:股前外侧皮瓣是头颈部各种软组织缺损修复重建中一个很有价值和应用潜力的供区,具有成功率高,对供区影响小的特点。

Background and Objective. Although anterolateral thigh （ALT） flap has the advantage of limited damage to the donor site, its clinical application is not common. This study was to study the clinical value of ALT flap in the reconstruction of head and neck soft tissue defects. Methods： Twenty patients receiving reconstruction of head and neck soft tissue defects using ALT flap at Sun Yat-sen University Cancer Center between November 2004 and May 2008 were retrospectively reviewed. Surgical procedures in the harvest of ALT flap were described. The surgical anatomy and successful rate were reported. Results. Twenty patients were all alive. The vessel pedicle length of ALT flap ranged from 5 cm to 14 cm, with an average of 9.9 cm. The harvested ALT flap was （4-9） cm × （6-16） cm. The skin perforator was classified into four cases of intermuscular septal branch （20%） and 16 cases of musculocutaneous branch （80%）. The head and neck soft tissue defects included 14 cases （nine cases of tongue and oral floor, three cases of buccal mucosas, one case of hard palate, and one case of retromolar trigone mucosa） intraoral mucosa and six cases of facial-cervical skin defects. Except for one case, the donor sites were primarily sutured. Conclusion. ALT flap is one of valuable and potential donor site for the reconstruction of head and neck soft tissue defects. It could achieve a high successful rate and causes little influence to the donor sites.