背阔肌组织瓣在口腔颌面外科中的应用

Use of latissimus dorsi tissues flap in oral and maxillofacial reconstruction

目的 探讨背阔肌组织瓣的应用解剖学特点 ,及其在口腔颌面外科组织缺损和功能重建中的用途及优缺点 .方法 对 5 1例背阔肌组织瓣整复口腔颌面部缺损或畸形的病例进行临床分析总结 .结果 5 1例组织瓣均成活 ,成活率10 0 % .肌皮瓣有效地修复了组织缺损 ,解除了烧伤疤痕引起的颌颈粘连 .肌瓣整复面部萎缩畸形 8例术后外形丰满对称 .节段肌瓣治疗面瘫 2 4例术后 8～ 12 mo随访功能重建优良率 83.3% .结论 背阔肌可以形成肌瓣、肌皮瓣或骨肌皮瓣 ,组织量充分 ,是口腔颌面部组织缺损修复、面部畸形整复及功能重建的良好材料 ,手术并发症率低 .其缺点是术中需变换患者体位 ,不利于两组人员同时操作 。

AIM To investigate the applied anatomy characteristics of latissimus dorsi tissues flap and its use for tissues defect repairing and functional reconstruction in oral and maxillofacial region. METHODS The clinical records of 51 cases of latissimus dorsi tissues flap transfer were summed up and analyzed. RESULTS All 51 flaps survived well, with a success rate of 100%. The tissues defects were repaired and the scar adhesions were relieved effectively by latissimus dorsi myocutaneous flap. The atrophy side of face was cured by transfer of muscle flap, appearance was improved obviously. The paralyzed side of face was functionally reconstructed by transfer of segmental muscle flap with a ultra long neurovascular pedicle, the good rate of function regain from 8 to 12 mo postoperatively was 83.3%. CONCLUSION Latissimus dorsi can be made into muscle flap, myocutaneous flap or myocutaneoosseous flap, and can provide sufficient soft tissues with neurovascular pedicle which is suitable for tissues defects repairing and functional reconstruction in oral and maxillofacial region. The main disadvantage of the flap is the need of changing patient's posture intraoperatively, which does not facilitate two teams working simultaneously, thus increasing the average operating time.