游离下腹直肌肌皮瓣全舌再造术

A free inferior rectus abdominis flap for total tongue reconstruction

目的 本文报告舌全切除术后下腹直肌肌皮瓣全舌再造的新方法。方法 先行患侧颈清及对侧舌骨上淋巴清扫术 ,保留对侧颌外动、静脉为供区血管。将全舌切除后取一侧下腹直肌肌皮瓣游离微血管吻合移植全舌再造。结果 下腹直肌肌皮瓣有恒定的下腹直肌深动、静脉血管为肌皮瓣之血管蒂 ,该蒂可取长约 4～ 6cm ,血管动脉直径 3 .5～ 5mm ,静脉直径 4～ 6mm ,可与甲状腺上动、静脉 ,颌外动、静脉行端 -端吻合。腹直肌与口底肌肉、皮瓣后端与舌骨、两侧前端与口底粘膜缝合。该肌皮瓣行舌再造后有足够的容积 ,能使患者最大限度地恢复吞咽及语言功能。结论 游离下腹直肌肌皮瓣微血管吻合行舌再造是一个可被推荐的新方法。

Objective A new method for total tongue reconstruction with a free inferior rectus abdominis flap will be reported.Methods After the isolateral neck dissection and contralateral surprahyoid,dissection to retain external maxillary artery and vein to serve as recipient vessels and the total glossectomy have been performed,the total tongue reconstruction with a free interior rectus abdominis flap will be made.Results The deep epigastric arcade forms the abdominal portion of a ventral vascular railroad linking the subclavian and external iliac arteries.Branch lines from this system have formed the basis of various axial flaps used in reconstructive surgery.The vascular pedicle of the free inferior rectus abdominis flap is long,the vessels are large caliber(artery average 3.4 mm,vein average 4.0 mm).In the recipient vessels used for anastomoses,the most commonly used artery was the superior thyroid artery,followed by the superficial cervical artery.All arteries were anastomosed end-to-end.The external jugular vein and the facial vein were the most commonly used recipient vein,followed by the internal jugular vein.Inferior rectus abdominis was sutured with the muscles of the floor of the mouth,the flap was sutured circumferentially to the pharyngeal and oral muscosa.The rectus free tissue transfer provides soft tissue bulk and a large skin paddle,which can be designed and a large skin paddle,which can be designed in the vertical,oblique,or transverse orientation,allowing reconstruction of complex threedimensional defect.Conclusion Free inferior rectus abdominis flap anastomosed vessels for total tongue reconstruction is a new method which can be recommended.