游离组织瓣在口腔-颌面头颈肿瘤缺损修复中的应用

The application of free flap in oral-maxillofacial defects in head and neck tumors

目的探讨游离组织瓣移植在由腔颌面头颈肿瘤缺损修复术中的应用价值。方法选择154例口腔颌面组织缺损患者，有50例为舌口底区缺损，13例为面颊腭部缺损，35例为上颌骨缺损，27例为下颌骨缺损，28例为上颌骨缺损。对所有缺损患者行游离组织瓣口腔颌面部缺损修复术，其中前臂皮瓣43例，腓骨复合组织瓣15例，膈骨肌皮瓣24例，股前外侧皮瓣皮瓣26例，游离胸大肌皮瓣12例，腓骨肌组织瓣15例，其它游离组织瓣34例，回顾性分析其成活率及术后并发症。结果154例游离组织瓣成活率为96．75％，其中前臂皮瓣成活率为97．67％，膈骨肌皮瓣成活率为95．83％，股前外侧皮瓣成活率为96．15％，游离胸大肌皮瓣成活率为91．67％，腓骨肌组织瓣成活率为93．33％，股前外侧皮瓣成活率为100．00％；154例中，138例患者清晰度达90．00％以上，另外16例患者语言清晰度达70．00％。结论口腔颌面部创伤性组织缺损采用游离组织瓣移植重建具有一定的安全性和有效性，最常用的游离组织瓣为前臂皮瓣和腓骨瓣，修复成功率高，术后语言功能恢复情况好，值得临床推广应用。

Objective To investigate the free tissue flap in oral and maxillofacial surgery in head and neck cancer defects application value. Methods 154 cases of oral and maxillofacial tissue defects,50 cases of tongue- mouth floor area defects, 13 cases of cheek palate defect,35 cases of maxillary defect,27 cases for the mandible, 28 cases of maxillary defects were selected. All patients underwent defect for free flap surgery oral and maxillofacial defects, of which 43 cases of forearm flap, fibula composite flap 15 cases,24 cases of diaphragmatic bone flap, antero- lateral thigh flap flap 26 cases,free chest major muscle flap in 12 cases, 15 cases of fibula flap,the other free flap, 34 patients were retrospectively analyzed the survival rate and postoperative complications. Results 154 cases of free flap, the survival rate was 96.75 %. Which forearm flap survival rate was 97.67 % ;phrenic bone flap survival rate was 95.83% ;anterolateral thigh flap survival rate was 96.15% ;free pectoralis major flap survival rate was 91.67% ;fibu- la flap survival was 93.33% ;anterolateral thigh flap survival rate was 100.00%. Determination of the language defini- tion, 154 patients, 138 patients more than 90.00% clarity,while 16 patients more than 70.00% speech intelligibility. Conclusion Oral and maxillofacial traumatic tissue defects using free tissue flap reconstruction has certain safety and efficacy, the most common forearm free flap and fibula. Traumatic soft tissue defects in the early positive selection of free flap can effectively prevent tissue deformation and shift repair success rate, postoperative language function recov- ery is good, it is worthy of clinical application.