游离组织瓣移植修复头颈部肿瘤术后组织缺损的临床分析

Free composite flap transplantation use for head and neck reconstruction

目的探讨吻合血管的游离组织瓣在头颈肿瘤术后组织缺损修复中的应用。方法2 0 0 3年5月～2 0 1 2年4月收集头颈肿瘤术后组织缺损患者1 0 0例,其中口腔4 7例,口咽部1 6例,下颌骨9例,颌面部20例,颈部6例,项背部2例;所有患者应用吻合血管的游离组织瓣(101处)修复组织缺损,其中游离前臂皮瓣61处,游离背阔肌皮瓣18处,游离腓骨肌皮瓣7处,游离腹肌穿支皮瓣2处,游离股前外侧皮瓣1 0处,游离髂骨肌瓣2处,游离肩胛皮瓣1处;观察游离组织瓣修复组织缺损处后的愈合情况。结果术后随访2个月至5年,患者术后外形及功能均恢复正常,101处游离组织瓣术后成活98处,坏死3处,成功率97.03%。受区和供区的并发症12/101(11.8%)。结论游离组织瓣移植在头颈外科修复中应用安全灵活且可供选择的组织瓣多,提高了患者的生存质量。

Objective To evaluate the effects of free composite flap transplantation on reconstruction of postoperative defects of head and neck. Methods Clinical data of 101 consecutive free flap transfers performed in 100 patients from 2003 to 2012 was studied retrospectively. Accoding to the donor sites, the free flaps included free radial forearm flaps （ n = 61 ） , latissimus dorsi flaps （ n = 18 ） , free fibula flaps （ n = 7 ） , rectus abdominis flaps （n=2）, anterolateral thigh flaps （n = 10）, iliac bone flaps （n = 2）, and scapular flaps （n = 1）. The reconstruction sites included oral region （ n = 47 ）, oropharyngeal region （ n = 16 ） , mandible region （ n = 9 ） , maxillofaeial region （ n = 20 ） , neck region （ n = 6 ） , neck and back region （ n = 2 ） . To observe the healing of free tissue flap transplantation. Results All the patients were followed up for 2 months to 5 years postoperatively. Of all the 101 flaps, 98 survived and necrosis occurred in 3. The total survival rate of flaps was 97. 03% , with a postoperative complication rate of 11. 8% （ 12/101 ）. The patients were generally satisfied with their shape and function. Conclusions With various donor tissues, free tissue flap transplantation is reliable and safe in the reconstruction of postoperative defects in head and neck.