前臂桡侧皮瓣与股前外侧皮瓣修复半舌缺损的比较研究

Comparative studies on tongue reconstruction after hemiglossectomy with radial forearm flap versus anterolat-eral thigh flap

目的：分析比较前臂桡侧皮瓣与股前外侧皮瓣在修复半舌缺损后的舌功能恢复和供受区并发症情况。方法：2008年7月-2012年11月，23例舌癌患者接受肿瘤扩大切除，遗留的半舌缺损，14例采用前臂桡侧皮瓣修复，供区伤口取腹部全厚皮片移植修复；9例采用股前外侧皮瓣修复。术后4~6个月，对每例患者的吞咽功能、语言清晰度和供受区并发症等情况进行随访分析。结果：前臂桡侧皮瓣组和股前外侧皮瓣组患者吞咽功能和语言清晰度均恢复良好，两组之间无显著差异。在受区，前臂桡侧皮瓣组有1例出现全部皮瓣坏死；股前外侧皮瓣组有1例出现小部分皮瓣坏死，1例出现口颈瘘。在供区，前臂桡侧皮瓣组有4例出现移植皮片部分坏死，1例伤口部分裂开，12例出现明显的瘢痕，9例局部麻木，3例手臂功能障碍；股前外侧皮瓣组有1例局部麻木，1例出现明显的瘢痕，均未出现运动功能障碍。前臂桡侧皮瓣组供区并发症明显多于股前外侧皮瓣组。结论：股前外侧皮瓣可获得的血管蒂长、管径大、供区并发症少，是半舌缺损较理想的修复组织瓣。

Objective：To evaluate swallowing and speech function and donor-site morbidity in patients with tongue carcinoma surgically treated and reconstructed with radial forearm flap or anterolateral thigh flap. Method：Twenty-three patients underwent primary reconstruction after hemiglossectomy between July 2008 and December 2012. Fourteen patients were reconstructed using a radial forearm flap,and the donor-site closure were carried by skin graft. The remaiming were reconstructed with an anterolateral thigth flap. All of them were followed postoperatively to determine their swallowing and speech functional outcome and recipient and donor site morbidity after 4-6 months. Result：The functional results with both flaps were adequate,and the two groups did not differ significantly between each other for either swallowing or speech. In recipient site,the radial forearm flap group had 1 patients with complete flap loss,and the anterolateral thigh flap group had 1 patients with partial flap loss and 1 patients with orocutaneous fistula. In donor site,the radial forearm flap group had 4 patients with partial skin graft failure, 1 patient with wound dehiscence,12 patients with hypertrophic scarring,9 patients with numbness of skin-grafted area and 3 patients with function impairment; however,the anterolateral thigh flap group had 1 patients with hypertrophic scarring and 1 patients with numbness of donor area. The patients in the radial forearm flap group developed a greater number of overall donor site complications compared with those in the anterolateral thigh flap group. Conclusion：The anterolateral thigh flap,with a long pedicle,suitable vessel diameter, and low donor site morbidity,could be the ideal flap for hemiglossectomy defect reconstruction.