胸锁乳突肌—锁骨复合肌骨皮瓣修复口腔癌术后复合缺损

Using sternocleidomastoid-clavicle myocutaneous flap to reconstruct compound operative defect of oral carcinoma

目的研究口腔癌术后软硬组织复合缺损的重建修复术式,即胸锁乳突肌—锁骨复合肌骨皮瓣(SCMCP),总结其临床应用效果、预后及优点,探索并研究SCMCP联合同期牙种植体植入的新术式。方法 2007—2009年,采用SCMCP修复术后复合缺损患者共16例。该16例患者均在口腔癌局部扩大切除联合颈淋巴结清扫术的同期采用SCMCP修复术后复合缺损,其中4例(25.00%)术中同期于移植的锁骨瓣处植入牙种植体。结果 16例患者随访期间无死亡病例。1例颊癌(6.25%)局部复发,二次手术切除后,局部皮瓣至今生长良好;2例(12.50%)皮瓣边缘部分表皮脱落;2例(12.50%)锁骨处少量积液;1例(6.25%)术中锁骨骨折;其余病例修复效果满意。所有患者术后具有较好的进食与发音功能。结论 SCMCP制作简单,存活率高,保留部分锁骨后对供区外形及功能影响较小,是一种修复口腔癌术后复合组织缺损较好的手术方式。

Objective To study the sternocleidomastoid-clavicle myocutaneous flap（SCMCP） for repairing the compound operative defect after oral carcinoma resection,to observe its clinical effect,prognosis and advantages of SCMCP,and to develop a new operative method that implantation of dental implant can be performed simultaneously.Methods Sixteen patients underwent reconstruction with SCMCP after oral carcinoma resection and neck dissection during 2007 to 2009.Four of them（25.00%） underwent simultaneously implantation of dental implants in the clavicular flaps.Results None of these patients died postoperatively during the follow-up until now.One patient（6.25%） with buccal cancer encountered local recurrence resulting in reoperation,and the flap grows well up to now.A part of the skin paddle un-derwent necrosis in two patients（12.50%）,local fluidity was found in 2 patients（12.50%）,fracture of clavicle occurred during the operation in one patient（6.25%）.All the patients had good pronunciation and oral diet with no difficulty. Conclusion SCMCP is easy to survive,simple to perform,the clavicular figure and function won＇t be destroyed signi-ficantly.SCMCP is a good operative method to repair the compound operative defect after oral carcinoma resection.