带蒂肌皮瓣修复口腔颌面部缺损的临床研究

Vascularized Myocutaneous Flaps in the Reconstruction of Oral and Maxillofacial Large Tissue Defects

目的:探讨胸大肌皮瓣、胸锁乳突肌皮瓣、额肌皮瓣与钛板联合修复口腔颌面部缺损的效果。方法:对47例舌癌、19例口底癌行颌颈联合根治术遗留的下颌骨及其邻近软组织缺损,采用大小为6 cm×7 cm带蒂胸大肌肌皮瓣、3 cm×5 cm胸锁乳突肌皮瓣、额肌皮瓣与钛板即刻修复。对1例上颌骨骨癌遗留的巨大缺损,采用大小为9 cm×25 cm的带蒂胸大肌肌皮瓣即刻修复。对39例颊黏膜癌行颊颌颈联合根治术遗留的颊部缺损,采用大小为6 cm×5 cm或3 cm×5 cm带蒂额肌皮瓣即刻修复。回顾性分析这106例的修复效果。结果:随访6～24个月,106例移植的肌皮瓣中,105例全部成活、1例胸锁乳突肌肌皮瓣有小部分表皮坏死;面部外形基本满意,张口度2.5～4.4 cm,余留牙的咬合关系恢复良好。结论:带蒂肌皮瓣修复颌面缺损是修复口腔颌面部缺损较理想的方法。

Objective:To evaluate the clinical effects of combined vascularized myocutaneous flap with titanium plate in reconstruction of large defects in oral and maxillofacial region.Methods:The pedicled pectoralis major myocutaneous flaps(6 cm×7 cm) and sternocleidomastoid flaps(3 cm×5 cm) and forehead flap(3 cm×5 cm) combined with titanium plates were applied immediately to repairing mandible and adjacent soft tissue defects,when combined radical operation of jaw and neck were performed in 47 cases of tongue carcinoma,19 cases of mouth floor carcinoma.The pedicled pectoralis major myocutaneous flaps(9 cm×25 cm) were used in 1 cases of maxilla carcinoma.The pedicle frontal myocutaneous flaps(6 cm×5 cm or 3 cm×5 cm) were used for immediate repairing buccal defects,when combined radical operation of buccal,jaw and neck were performed in 39 cases of buccal mucosa carcinoma.The effects of reconstruction in these 106 cases were retrospectively analyzed.Results:Transplanted myocutaneous flaps of 105 cases were survived during 4-24 months following-up.A small portion of skin necrosis in 1 case was occurred in the sternocleidomastoid myocutaneous flap.All facial appearances were satisfactory and mouth-open extents were 2.5 -4.4cm.Normal occlusion was restored. Conclusion:Vascularized myocutaneous flaps may be applicable in the restoration of oral and maxillofacial defects.