应用血管化游离组织瓣修复口腔颌面部缺损168例临床分析

Clinical analysis of microsurgical free flap for oral and maxillofacial region reconstruction

目的:总结提高显微外科皮瓣修复口腔颌面部缺损成功率的经验。方法:2006年至2010年中国医科大学口腔医学院口腔颌面外科共行显微外科游离皮瓣移植修复口腔颌面部缺损168例,其中前臂游离皮瓣90例,股前外侧游离皮瓣39例,腓骨肌皮瓣31例,背阔肌皮瓣8例。术后观察皮瓣成活率和并发症。结果:皮瓣成活164例(97.6%),失败4例,11例患者出现术后早期局部并发症(6.5%);术后皮瓣危象发生率为5.4%(9/168),其中静脉血栓形成6例(66.7%),手术探查抢救成功率55.6%(5/9);前臂桡侧皮瓣成活率97.8%(88/90),股前外侧皮瓣成活率97.4%(38/39),腓骨肌皮瓣成活率96.8%(30/31),背阔肌皮瓣8例全部成活。随访2～2.5a,93%的患者面部外形对称,开口度及咬合关系正常,舌体运动及吞咽功能良好。结论:显微外科游离皮瓣移植的成活率高,保证动脉血供和静脉回流是移植成功的关键,术后5d内要密切观察皮瓣情况,一旦出现危象,应在6h内进行积极手术探查。及时手术探查是提高皮瓣抢救成功率的关键。

PURPOSE： To summarize the experience of improving survival rate of microsurgical free flap transfers for oral and maxillofacial reconstruction.METHODS： One hundred and sixty-eight consecutive microsurgical free flap transfers performed in patients with oral and maxillofacial defects after surgical procedure due to carcinoma from March 2006 to August 2010 were reviewed.The series included 90 free radial forearm flaps,31 free fibular flaps,39 anterolateral thigh flaps and 8 latissimus dorsi musculocutaneous flaps.The microsurgical free flap survival rate and postoperative complication were evaluated.RESULTS： The overall success rate of flap was 97.6%（164/ 168） The overall complication rate was 6.5%（11/168）.The flap crisis rate was 5.4%（9/168） including venous thrombosis in 6/9 cases,and the flap salvage rate was 55.6%（5/9）.Survival rate of radial forearm free flap,anterolateral thigh flap,fibular flap and latissimus dorsi musculocutaneous flap was 97.8%,97.4%,96.8% and 100%,respectively.Facial symmetry,swallowing and occlusion of the patients were satisfactory after 2 to 2.5 years of follow-up.CONCLUSIONS： Microsurgical free flap transfer for oral and maxillofacial region is safe and reliable.The key point was to guarantee arterial blood supply and venous drainage.To promptly discover blood vessel crisis after operation in the first 5 days and immediate surgical exploration within 6 hours when there were a crisis of blood vessel is crucial for improving successful free flap salvage.