组织瓣移植在口腔颌面部软组织缺损修复中的应用

Application of Various Tissue Flaps Transfers For Reconstruction of the Defect of Oral and Maxillofical Soft Tissue

目的探讨几种组织瓣移植在口腔颌面肿瘤术后软组织缺损与修复中的应用价值。方法分析2006年4月至2008年12月间组织瓣移植患者34例,共制备皮瓣36块,包括胸锁乳突肌皮瓣、胸大肌皮瓣、前臂桡侧皮瓣,分别用于修复舌、腭、颊、口底、口咽及面颈部大面积复合缺损。分析各组织瓣移植的疗效。结果制备皮瓣36块中,皮瓣坏死4块。34例患者术后获随访1～3年,随访期间无1例病灶复发;7例区域复发,复发时间为术后4～12个月,均为术后淋巴结证实转移而术后又拒绝放疗、区域复发的患者。2例接受再手术治疗,4例死亡,其余患者均能经口腔进食,面部外形和功能均基本恢复正常。结论组织瓣移植是口腔颌面-头颈肿瘤手术根治的保障,更是术后缺损修复的主要手段,应根据不同适应证进行选择;采用不同组织瓣修复口腔颌面部缺损对患者术后外形及功能具有重要意义。

Objective To assess the results of various tissue flaps transfers in reconstruction of oral and maxillofacial soft tissue defects.Methods Thirty-six soft tissue flaps were performed in 34 patients during 2006～2008.This flaps included 9 sternodeiceomastoid myocutaneous flaps,19 pectoralis major myocutaneous flaps（PMMF）and 8 forearm free flaps.These flaps were used to reconstruct the defects of the tongue,palate,cheek,floor of mouth.Results Thirty-two flaps were completely survived.Necrosis happened in one patient who used free forearm flap and in three patients who used pectoralis major myocutaneous flap.AIl of the free flaps survived.During the follow-up of 1-3 years,none patient had recurrence in primary lesion,seven patients had recurrence in cervicaI lymph nodes,four died of recurrence in cervicaI lymph nodes.The appearance was satisfactory and the oral function was well in the other patients.Conclusion Reconstruction with tissue flap afford the great possibility for tumor resection.The tissue flap transplantation is the mainstay of oral and maxillofacial reconstruction.Selection and application of proper flap is important for esthetic and functional rehabilitation.