游离股前外侧肌皮瓣修复舌癌连续整块切除术后缺损

FREE ANTEROLATERAL THIGH MYOCUTANEOUS FLAP FOR RECONSTRUCTION OF SOFT TISSUE DEFECTS FOLLOWING EN BLOCK RESECTION OF TONGUE CANCER

目的探讨游离股前外侧肌皮瓣修复舌癌连续整块切除术后缺损的效果。方法2006年11月-2008年12月,对109例舌癌患者采用游离股前外侧肌皮瓣修复舌癌连续整块切除术后缺损。其中男75例,女34例;年龄23～75岁,平均50.4岁。病程1～6个月。根据2002年国际抗癌联盟(IUCC)标准行TNM分期:T2N0M035例,T2N1M08例,T2N2M02例,T3N0M031例,T3N1M012例,T3N2M07例,T4N0M05例,T4N1M04例,T4N2M03例,T4N3M02例。舌癌切除术后舌缺损范围为5cm×3cm～12cm×8cm。术中切取股前外侧肌皮瓣范围7cm×4cm～20cm×8cm。82例T3、T4及术后病理报告淋巴结阳性者配合术后放疗。观察术后皮瓣成活情况及伤口愈合情况,并随访评价再造舌形态、功能,皮瓣供区功能及皮瓣对术后放疗的耐受性。结果5例术后5～7d出现口底下颌下漏;大腿供区1例出现皮下积液,1例出现伤口裂开;均经换药后愈合。其余供受区切口均Ⅰ期愈合,植皮均成活。105例肌皮瓣完全成活,成活率为96.3%;3例术后3～5d出现皮瓣远端或边缘局部坏死,均经换药后愈合;1例术后3d出现皮瓣完全坏死而被清除,改用胸大肌皮瓣修复。8例皮瓣修薄患者术后1d皮瓣出现水疱,抽去水疱内容物后痊愈。患者均获随访,随访时间0.5～2.5年,平均1.2年。再造舌稍萎缩,但外形仍丰满,舌颌沟深浅适度,无下颌下区凹陷;语言及吞咽功能恢复满意。供区瘢痕隐蔽,下肢无功能障碍。放疗患者未出现皮瓣坏死。结论游离股前外侧肌皮瓣安全可靠,修复效果好,对供区影响小,术后并发症少,对放疗耐受性好,是修复舌癌连续整块切除术后缺损的理想皮瓣。

Objective To evaluate the results of the reconstruction of the soft tissue defects following the en block resection of tongue cancer using free anterolateral thigh myocutaneous flaps.Methods From November 2006 to December 2008,109 cases underwent the reconstruction of the soft tissue defects following the en block resection of tongue cancer using free anterolateral thigh myocutaneous flaps.There were 75 males and 34 females with an age of 23-75 years（50.4 years on average）.The disease course was 1-6 months.According to 2002 International Union Control Cancer（IUCC）criterion for TNM stage,there were 35 cases of T2N0M0,8 cases of T2N1M0,2 cases of T2N2M0,31 cases of T3N0M0,12 cases of T3N1M0, 7 cases of T3N2M0,5 cases of T4N0M0,4 cases of T4N1M0,3 cases of T4N2M0,and 2 cases of T4N3M0.The range of tongue defect was 5 cm×3 cm to 12 cm×8 cm.The flap area ranged from 7 cm×4 cm to 20 cm×8 cm.Eighty-two patients with T3,T4 and positive lymph node metastasis determined by pathological examination after operation received radiotherapy.The vitality of the flaps and the healing of the wounds were observed postoperatively.The shape and function of the reconstructed tongue were determined,the influences on function at donor site were evaluated and the flap tolerance to radiotherapy was investigated during the follow-up period.Results Mouth floor mandibular fistula occurred in 5 cases 5-7 days after operation,seroma formation in 1 case and wound dehiscence in another case at the donor site;the wounds healed by secondary intention after dressing.The other wounds healed primarily.All 105 flaps survived completely,3 flaps developed partial necrosis 3-5 days after operation,the wounds healed after dressing;and 1 flap failed 3 days after operation,then it was removed and defects was repaired using pectoralis major muscle flap.Blisters occurred in 8 flaps（all being thinning flaps）1 day after operation. The overall complete survival of the flap was 96.3%（105/109）.The patients were followed up for 0.5-2.5 years（1.2 years on average）.Although the flaps had a little atrophy,the shape of the reconstructed tongue was still satisfactory with suitable tongue- mandibular groove.No depression was observed in the mandibular region.The speech as well as swallowing function were well recovered.The scar was easily hidden with no important functional impairment at the donor site.No flap necrosis occurred in all the patients who received postoperative radiotherapy.Conclusion Free anterolateral thigh myocutaneous flap transplantationis safe and reliable,and it has the advantages of the better result at the recipient site,the less morbidity at the donor site,fewer postoperative complications and excellent tolerance to radiotherapy.So it is an ideal flap to repair soft tissue defects following the en block resection of tongue cancer.