晚期口腔癌术后颊部大范围洞穿性缺损的修复

Reconstruction of major full cheek defects with combined extensive pedicled supraclavicular fasciocutaneous island flaps and extended vertical lower trapezius island myocutaneous flaps following ablation of advanced oral cancer

目的:评价延长锁骨上岛状筋膜皮瓣联合延长垂直下斜方肌岛状肌皮瓣修复晚期口腔癌术后颊部大范围洞穿性缺损的可行性。方法:对我院2008年6月—2012年2月施行的17例延长锁骨上岛状筋膜皮瓣联合延长垂直下斜方肌岛状肌皮瓣修复晚期口腔癌切除后颊部黏膜和皮肤巨大洞穿性缺损病例进行回顾分析。结果:17例患者均伴晚期口腔癌切除后的颊部软硬组织巨大洞穿性缺损,修复口腔衬里的延长锁骨上岛状筋膜皮瓣大小为10 cm×8 cm～14 cm×10 cm,修复外部缺损的延长垂直下斜方肌岛状肌皮瓣大小为15 cm×8 cm～25 cm×10 cm。所有病例均无严重并发症,随访6～34个月,9例患者无瘤生存,2例带瘤生存,6例死于局部复发及远处转移。结论:应用延长锁骨上岛状筋膜皮瓣复合延长垂直下斜方肌岛状肌皮瓣修复晚期口腔癌术后颊部大范围洞穿性缺损是一种可靠的修复方法,对于再次手术,以及放疗后病例,在一定程度上优于游离皮瓣等其他修复方法。

PURPOSE： This clinical study assessed the feasibility of extensive pedicled supraclavicular fasciocutaneous island flaps combined with extended vertical lower trapezius island myocutaneous flaps for large, full-thickness cheek defect reconstruction following ablative oral cancer surgery. METHODS： A retrospective review of data from consecutive cases requiring extensive pedicled supraclavicular fasciocutaneous island flaps （SFIFs） and the extended vertical lower trapezius island myocutaneous flap （TIMF） to provide both an inner and an outer lining for major full-thickness cheek defects following oncological resections taking place. RESULTS： Seventeen patients had advanced oral SCC. All patients had combined bone and extensive soft-tissue defects. The extensive pedicled SFIF with a skin paddle measuring between 10 cm×8 cm and 14 cm×10 cm and the extended vertical lower TIMF with a skin paddle measuring 15×8 cm to 25×10 em were used to reconstruct the major through-and-through defects. There was no major complication in any patient. The patients were followed-up for 6-34 months, nine of them survived with tumor, two survived without tumor, and six died of local recurrence. CONCLUSION： The combined use of the extensive pedicled SFIF with an extended vertical lower TIMF to reconstruct major through-and-through cheek soft defects is reliable, and is an excellent alternative to other pedicled or even microsurgical free flaps, for patients who have previously undergone radiation and surgery of the head and neck.