口腔软组织缺损带蒂组织瓣即刻修复346例回顾性研究

A retrospective study of 346 pedicle flaps in reconstruction of oral soft tissue defects

目的探讨几种常用带蒂组织瓣行口腔软组织缺损即刻修复的可行性,比较各瓣的优缺点,并为带蒂组织瓣的选择提出建议。方法对武汉大学口腔医学院1985—2006年期间346例口腔恶性肿瘤切除后软组织缺损患者,采用单一带蒂组织瓣行即刻修复的临床资料进行回顾性分析。疗效评估包括修复部位、修复方法、组织瓣大小、手术时间、鼻饲管和气管切开术使用率、皮瓣相关并发症、皮瓣供区美学评价、住院时间及住院费用等。结果组织瓣总成功率为94.2%,其中108例带蒂组织瓣术后出现了不同程度的并发症(31.2%)。并发症发生率与术前放疗关系密切(P<0.05)。鼻饲管及气管切开术的使用率与修复部位有关。在供区美学评价中,颈阔肌皮瓣(87%)和胸锁乳突肌皮瓣(81%)具有较高的满意度。结论胸大肌皮瓣适于修复组织缺损大的口咽以及舌、口底缺损;对于早期口腔癌切除后中小型软组织缺损且术前未行放疗的患者,颈部带蒂组织瓣是一种较好的选择;而对美观要求不高,身体状况欠佳的大面积颊黏膜缺损可采用额瓣修复。

ObjectiveTo retrospectively study the clinical data of several pedicle flaps used in reconstruction of soft tissue defects following oral malignant tumor resection and offer some references for pedicle flaps application.MethodsA retrospective case series of 346 pedicle flaps which were used in the same number of patients during the period of 1985 to 2006 at the Hospital of Stomatology at Wuhan University was included in this study.The factors to be evaluated and compared included the defect site,methods of reconstruction,operating time,size of the skin paddle harvested,nasogastric tube and tracheotomy application rate,flap-related complications,hospital stay length and hospitalization costs.ResultsThe overall success rate of the flaps in the procedures was 94.2%,while 108 experienced different degrees of postoperative complications.The flap-related complication was closely related with preoperative radiotherapy(P<0.05).In addition,the application rate of nasogastric tube and tracheotomy were related to the defect site.In esthetic evaluation of the donor site,the platysma myocutaneous flap(87%)and sternocleidomastoid myocutaneous flap(81%)both had high satisfactory rates.ConclusionThe pectoralis major myocutaneous flap was mainly adapted to repair huge tissue defects.Cervical pedicle flap was a good choice to reconstruct small-and medium-sized defects following early stage of oral cancer.Reconstruction of defects with the forehead flap was suitable for patients with a large buccal mucosa defect and those who didn't pay much attention on aesthetics.