后桡侧副动脉穿支嵌合瓣修复舌癌术后缺损的早期疗效

EARLY EFFECTIVENESS OF POSTERIOR RADIAL COLLATERAL ARTERY PERFORATOR COMPOUND FLAP FOR RECONSTRUCTION OF TONGUE DEFECTS AFTER TUMOR EXCISION

目的总结应用后桡侧副动脉(posterior radial collateral artery,PRCA)穿支嵌合瓣修复舌癌术后软组织缺损的临床效果。方法 2011年8月-10月,收治舌部鳞状细胞癌男性患者5例。年龄43～71岁,平均59岁。病程25～60 d,平均42 d。舌癌病灶扩大切除后,3例1/3舌及口底组织缺损,2例1/2舌及口底组织缺损。应用PRCA设计制备游离延展上臂外侧皮瓣(extended lateral arm free flap,ELAFF)与肱三头肌肌瓣(triceps muscle flap,TMF)形成嵌合瓣,一期修复舌部软组织缺损。ELAFF切取范围为7 cm×5 cm～9 cm×5 cm,TMF为3 cm×3 cm～4 cm×4 cm。供区直接拉拢缝合。结果术后嵌合瓣均顺利成活,创面Ⅰ期愈合;供区切口均Ⅰ期愈合。患者术后均获6个月随访。术后舌体外形及运动良好,发音较清晰,吞咽无障碍。随访期间肿瘤均无复发。供区肘关节功能正常,局部有轻微麻木感。结论应用PRCA穿支制备游离ELAFF及TMF并形成嵌合瓣修复舌部软组织缺损,其血供可靠,手术操作简便,能提高修复效果,并发症少,是舌癌切除后缺损修复的较好选择之一。

Objective To summary the application and effectiveness of the posterior radial collateral artery（PRCA） compound flap in reconstruction of soft tissue defect after tongue cancer excision.Methods Between August 2011 and October 2011,5 patients with squamous cell carcinoma underwent tongue defects reconstruction with compound flap with extended lateral arm free flap（ELAFF） and triceps muscle flap（TMF） after ablation in one-stage.All patients were male with an average age of 59 years（range,43-71 years）.The disease duration was 25-60 days（mean,42 days）.After extended resection,3 cases had 1/3 tongue and mouth floor defect,and 2 cases had 1/2 tongue and mouth floor defect.The size of ELAFF ranged from 7 cm × 5 cm to 9 cm × 5 cm,and the size of TMF ranged from 3 cm × 3 cm to 4 cm × 4 cm.The donor sites were directly sutured.Results All compound flaps survived.The wounds at donor sites and recipient sites healed primarily.The patients were followed up 6 months.After operation,the tongue had good appearance and motion;the patients had clear voice and no dysphagia.No recurrence was observed during follow-up.Local numbness appeared at the donor sites,but the function of the elbows was normal.Conclusion The application of the compound flap of ELAFF and TMF based on PRCA perforator is a better option to reconstruct tongue defects for its reliable blood supply,appropriate thickness,easy operative procedures,and less complication.