带观察窗皮岛设计的游离股前外侧皮瓣修复下咽环形缺损的临床分析

The application of free anterolateral thigh flap with a reporter skin paddle in the reconstruction of circumferential hypopharyngeal defects

目的分析应用游离股前外侧皮瓣（anterolateral thigh，ALT）修复下咽环形缺损的近期效果。方法回顾性分析2012年3月至2014年9月，设计带观察窗皮岛的游离股前外侧皮瓣修复收治于中山大学肿瘤防治中心头颈外科和汕头大学医学院附属肿瘤医院头颈外科的22例下咽环形缺损患者的病历资料。通过观察近期修复效果总结该技术的要点、优势和并发症。结果环形下咽缺损的长度7-9cm。切取的ALT皮瓣大小（8～9）cm×（11～18）cm。设计观察窗皮岛的面积（2．0～3．0）cm×（2．5-4．0）cm。移植皮瓣存活率为91％（20／22）。2例发生皮瓣坏死的患者采用带蒂胸大肌皮瓣进行二期重建。所有患者术后吻合口均通畅。59％患者（13／22）术后进食吞咽主观评价为好；41％（9／22）患者术后吞咽一般。3例（14％）患者术后出现咽瘘，其中1例咽瘘可以短期自愈，另外2例需要二期手术修补。结论带观察窗皮岛的游离股前外侧皮瓣修复下咽环形缺损稳定性高，技术相对简单，创伤小而且术后功能恢复好。

Objective To study the short-term resuhs and technological improvement of free anterolateral thigh （ALT） flaps in the reconstruction of circumferential hypopharyngeal defects. Methods The free ALT flap with a reporter skin paddle was used in 22 cases with circumferential hypopharyngeal defects. The short-term results of reconstructive surgeries and key points, advantages and complications of this technique were summarized. Results The length of circumferential hypopharyngeal defects ranged from 7 to 9 cm. ALT flap with an area of （8 -9） cm Х （ 11 - 18）cm was harvested. A reporter skin island with the skin area of （2.0 -3.0）cm Х （2.5 -4.0）cm was designed. 91% （20/22） of ALT flaps survived. Two cases with flap necrosis underwent second reconstruction with a pedicled pectoralis major flap. All the patients had patent anastomotic lumen. Good postoperative subjective swallowing evaluation was obtained in 59% （13/22） of patients ; 41% （9/22） of patients had acceptable swallowing results. Three patients （ 14% ） presented with postoperative pharyngocntaneous fistula. One case recovered spontaneously in short-term and other two cases received the second reconstructive surgery. Conclusions The application of free ALT flap with a reporter skin paddle in the reconstruction of circumferential hypopharyngeal defect is technologically easy and reliable, with satisfying swallowing function and limited trauma.