颈阔肌肌皮瓣局部转移术的临床应用研究

Clinical application research of platysmav myocutaneous flap local transfer

目的:研究颈阔肌肌皮瓣移位术整复口腔组织缺损的应用解剖、分类,移位术方法及整复效果。方法:2005年4月～2010年9月,采用颈阔肌肌皮瓣修复口腔内舌、颊、下颌,口底部肿瘤切除后软组织缺损19例(男11例,女8例),年龄36～80岁,平均46岁。颊粘膜癌6例,舌癌5例,下颌牙龈癌5例,口底癌3例。口腔颊部、舌部、下颌,口底区原发病灶切除后组织缺损范围:长5.0～6.0cm,宽4.5～6.5cm。采用病灶同侧颈阔肌皮瓣切取,行组织移位转入口腔内修复软组织缺损。皮瓣切取范围:长9.5cm,宽4.5cm。结果:经用这种组织瓣移位术方法完成的19例皮瓣手术后成活良好,皮瓣收缩不明显,口腔组织创面、张口度、舌运动度等口腔功能恢复良好。放疗后皮瓣维持原形态,无坏死、无萎缩。随访显示皮瓣长期愈合良好,无萎缩,适应口腔环境,皮肤组织粘膜化。供瓣区存在瘢痕,部分患者存在轻度影响头、颈部运动。结论:颈阔肌肌皮瓣血供明确、解剖恒定;邻近口腔组织缺损部位;皮瓣质地、范围适合口腔缺损整复,移位术后皮瓣成活稳定。

Objective To study the applied anatomy,classification,displacement method and plastic results of the platysma myocutaneous flap（PMF）.Methods From April 2005 to September 2010,using PMF to repair tissue defects of tongue,cheek,mandible and mouth floor after tumor resection.Total 19 cases,11 cases were male,8 cases were female,age form 36 to 80 years old,average 46 years old.Buccal mucosa carcinoma in 6,5 cases of tongue cancer,lower gingival carcinoma in 5 patients,and the mouth floor cancer is 3 cases.Oral buccal area,tongue area,mandible,mouth floor defects after excision of the primary lesion： length： 5.0 ~ 6.0 cm,width： 4.5~6.5 cm.The lesions with one-side PMF repairmend,flap is in a long range 9.5 cm and wide range 4.5 cm.Results One patient had distal flap necrosis and one had wound dehiscence.No total flap failures or fistulas occurred.No other major complications,such as nerve lesions or orocutaneous fistulas were observed.Satisfactory swallowing function was achieved within two weeks in all cases.A platysma myocutaneous flap is a versatile,easy-to-perform,one-stage procedure,and the outcome is best in adequately selected patients;it should not be adopted in patients who have undergone previous neck surgery or radiotherapy,or if radical neck dissection is planned.Conclusion The platysma myocutaneous flap is considered to be an ideal donor source due to its thin,pliable and sufficient colour matched skin nature.