两种游离皮瓣在口腔颌面部恶性肿瘤术后缺损修复中的应用

Clinical application of 2 kinds of free flaps for defect repair after malignant tumor resection

目的：探讨前臂皮瓣和股前外侧皮瓣两种游离皮瓣在口腔颌面部恶性肿瘤切除术后组织缺损修复中的应用价值。方法对该院口腔颌面外科2011年1月至2012年12月收治的经病理确诊的口腔颌面部恶性肿瘤患者53例，TNM分期为T2N0M0～T4N3M0，均行原发灶扩大切除、颈淋巴清扫术加游离皮瓣同期修复术，其中前臂皮瓣修复27例，股前外侧皮瓣修复26例。前臂皮瓣面积最小为3cm×4cm，最大6cm×8cm；股前外侧皮瓣面积最小4cm×6cm，最大8cm×13cm。结果前臂皮瓣成活率为92．59％（25/27），股前外侧皮瓣成活率为96．15％（25/26），两种皮瓣总成活率为94．34％。术后随访2～24个月，50例患者面部外形和功能恢复均良好。前臂皮瓣修复患者中有3例女性患者手臂供区瘢痕明显，2例男性患者供区手掌虎口感觉消失；股前外侧皮瓣修复患者中有1例女性患者大腿供区瘢痕明显，所有患者下肢运动功能未受明显影响。结论前臂皮瓣和股前外侧皮瓣均是口腔颌面部恶性肿瘤术后组织缺损的理想皮瓣。由于前臂皮瓣血管恒定和管径大，易于吻合，更适合初学者采用，而股前外侧皮瓣供区创面可直接拉拢缝合，不需植皮，同时供区创口也比前臂皮瓣更隐蔽。

Objective To investigate the application value of using 2 kinds of free flaps forearm flap and anterolateral thigh flap to repair oromaxillofacial defects after tumor resection .Methods 53 cases of oromaxillofacial malignant tumor diagnosed by patho-logical examination ,TNM stage T2 N0 M0 -T4 N3 M0 ,in the department of oral and maxillofacial surgery of this hospital from Jan . 2011 to Dec .2012 were performed the primary focal expanded resection ,radical dissection and the free flap simultaneous repair in-cluding forearm flap（27 cases） or anterolateral thigh flap（26 cases） .The size of the forearm flaps ranged from minimal 3 cm × 4 cm to maximal 6 cm × 8 cm ,while those of anterolateral thigh flap ranged from minimal 4 cm × 6 cm to maximal 8 cm × 13 cm .Results The survival rate of forearm flaps was 92 .59% （25/27） ,while which of anterolateral thigh flaps was 96 .15% （25/26） ,and the to-tal survival rate of 2 kinds of flaps was 94 .34% .All the patients were followed up for 2-24 months with good functional and es-thetic results in facial .In the patients repaired by forearm flaps ,3 female cases showed visible scars in donor sites ,and 2 male cases showed the disappearance of the skin sensation in the donor hand within an area between the thumb and index finger .In the patients repaired by anterolateral thigh flaps ,1 female case showed visible scars in donor sites ,and no case had the motor deficits .Conclusion The forearm flap and anterolateral thigh flap are ideal flaps for the oromaxillofacial reconstruction after malignant tumor resection .The forearm flap is more suitable for beginners to use because it has constant and large diameter vessels and easy to vascular anastomosis .The donor site of anterolateral thigh flap not only can be sutured directly without skin grafting ,but also more covert than forearm flap .