腓肠内侧动脉穿支皮瓣修复舌缺损的疗效评价

A clinical study on application of free medial sural artery perforator flap for tongue reconstruction

目的:研究运用游离腓肠内侧动脉穿支皮瓣修复半舌缺损的可行性与临床效果,为腓肠内侧动脉穿支皮瓣用于舌部缺损修复提供依据。方法:选取9例舌癌患者,术前利用CT血管造影(CTA)技术对腓肠内侧动脉穿支进行定位,术中运用腓肠内侧动脉穿支皮瓣行半舌缺损修复。对成功应用该皮瓣进行舌重建的8例患者,术后1个月以及3个月进行随访,评价舌部功能及供区状况。结果:腓肠内侧动脉穿支皮瓣血管蒂长,管径与颈部血管匹配,对供区损伤小,腓肠内侧动脉穿支皮瓣重建舌丰满,术后语音及咀嚼功能良好,舌部感觉功能欠佳。供区功能良好,仅留存线性瘢痕,供区未见明显并发症。结论:游离腓肠内侧动脉穿支皮瓣可成为舌缺损修复重建的另一种选择,其供区隐蔽,损伤小,皮瓣厚度适合舌部缺损修复,术后患者语音及咀嚼功能恢复良好。

PURPOSE： To investigate the feasibility and clinical effectiveness of using medial sural artery perforator flap for reconstruction of tongue defects, and to provide clinical applications of medial sural artery perforator flap in reconstruction of tongue defect. METHODS： Preoperative CT angiography（CTA） technique was performed in mapping the medial sural artery perforating branches in 9 Chinese adult patients with tongue squamous cell carcinoma. The perforator flap was used for tongue reconstruction in 9 patients. The function of reconstructed tongue and donor site were evaluated during 1 and 3 months postoperatively in 8 patients whose reconstructive tongue survived. RESULTS： The length of pedicle was long, the diameter of the vascular pedicle matched the recipient vessel in the neck region, with minor donor site complication. The reconstructed tongue was plump, the function of voice and swallowing was favorable, but the sensation was not good. As for the donor sites, all patients had only linear scars, there was no impact on their motor function. CONCLUSIONS： The medial sural artery perforator flap is thin and suitable for reconstruction of tongue defects. Postoperative voice and swallow are good. The donor site is unconspicuous without serious influence on shape and function. The medial sural artery perforator flap is an excellent alternative for tongue reconstruction.