肩胛骨肌皮瓣在上颌骨缺损修复的初步应用

Application of scapula osteomyocutaneous flap in the repair of maxillary defect

目的对采用游离肩胛骨肌皮瓣修复上颌骨缺损进行初步探讨。方法选择因鼻窦或1：3腔肿瘤需行外科手术，将导致颌面中部软、硬组织缺损，严重影响功能需要修复的4例患者，其中造釉细胞瘤、低度恶性黏液表皮样癌术后复发、颌骨肉瘤及鳞状细胞癌各1例。采用游离肩胛骨肌皮瓣进行口腔颌面复合缺损的三维修复。结果4例患者伤口均于术后2周愈合，3周左右顺利进食半流质饮食，1个月后语言交流清楚，2个月后随着组织水肿消退，3例配带义齿，颌面轮廓接近原貌，咀嚼功能部分恢复。1例上颌骨肉瘤患者术后9个月咽旁颅底再次肿瘤复发并肺转移，患者未再接受治疗，1年后死亡；其他3例分别随诊37、25、10个月，目前未见肿瘤复发。患者肩背供瓣区无明显功能障碍。cT、骨扫描显示移植骨血供良好。结论肩胛骨肌皮瓣具有血供可靠、切口隐蔽、供区功能影响小的特点，可供组织种类和组织量多，其骨瓣适形性及可塑性优于其他游离移植组织，是修复面部上颌骨复合缺损的一种比较满意的方法，但是种植体需要的骨基可能逊色于腓骨，另外手术过程中需要变换体位从而会延长手术时间。

Objective Preliminary study on free scapula osteomyocutaneous flap to repair maxillary defect. Methods Central maxillofacial soft and hard tissue defect after nasal sinus or oral tumor surgery was repaired with free scapual osteomyocutaneous flap in 4 patients to reconstruct their maxillofacial functions. The primary tumors included an ameloblastoma, a recurrent low-grade mucous epidermoid carcinoma a jaw sarcoma and a squamous cell carcinoma. Results All the 4 cases had good wound healing within 2 weeks after surgery, with no complications, could take in semifluid food after 3 weeks, and had clear language communication after 1 month. Three cases wore denture after 2 months and recovered maxillofacial contour and partial chewing function, and had no tumor recurrences with the follow-up of 37, 25 and l0 months respectively. One case of maxilla sarcomas had recurrence with invasion of parapharyngeal space and skull base and pulmonary metastasis 9 months after surgery, who gave up further treatment and died 1 year later. No obvious dysfunction occurred in shoulder and back donation sites and well blood supply in transplanted bones were showed with CT and bone scan. Conclusions Scapula osteomyocutaneous flap has some advantages including reliable blood supply, hidden incision and little affect on the donation site, and it can apply with multiple tissues including bone, muscle, and skin for repair. This flap also has good shape adaptability and availability. So scapula osteomyocutaneous flap is a satisfactory method for the repair of facial maxillary complex defects. But some limitations exist in the flap, by which less amount of bone can be applied and more operation time is required due to the changes of patient＇s body position during surgery.