颈阔肌皮瓣在颊癌术后缺损修复中的应用

Application of platysma myocutaneous flap in repairing the defect after resection of buccal carcinoma

目的探讨颈阔肌皮瓣在颊癌术后缺损修复中的应用价值。方法术前检查颊部及颌下淋巴结未见显性转移的颊癌患者40例,观察组及对照组各20例,均常规实施颊癌切除和择区性颈淋巴清扫术,观察组颊部缺损选择颈阔肌皮瓣修复,对照组选择前臂皮瓣修复。随访1年,观察并比较2组患者皮瓣成活、颈部活动度、开口度以及颊部皮瓣黏膜化情况。结果观察组皮瓣成活率与对照组相比,差异无统计学意义(χ2=0.013,P=0.909)。但观察组内,皮瓣绕下颌骨者出现远端坏死的发生率明显低于未绕下颌骨者,差异有统计学意义(χ2=3.429,P=0.044)。颈阔肌皮瓣术后1年供区疤痕明显软化,对颈部活动影响不大,2组颈部活动度差异无统计学意义(P>0.05)。2组患者术后1年的开口度及颊部皮瓣黏膜化情况均良好,差异无统计学意义(P>0.05)。结论颈阔肌皮瓣对于术前颊部及颌下淋巴结未见显性转移的颊癌患者的术后缺损具有较好的修复效果,尤其适用于颊部病灶切除后有牙列缺失者,以及手术风险较高不宜实施游离皮瓣者。与游离皮瓣相比,颈阔肌皮瓣具有手术创伤小、临床效果好、操作简单容易开展等优点。

Objective To investigate the application value of platysma myocutaneous flap in repairing the defect after resection of buccal carcinoma. Methods 40 patients(preoperative examination of regional lymph nodes showed no obvious metastases of buccal cancer) were selected during January 2008 to May 2014, 40 patients were divided into the observation group and control group equally and received the conventional implement buccal carcinoma resection and selective neck dissection. Observation group used platysma myocutaneous flap to repair the buccal defect, and the control group used forearm skin flap to repair the defect. After one year follow-up, the survival rate of the flaps, the neck activity after operation, and the opening degree of mouth were compared with these two groups. Results Compared with the control group, the survival rate of the observation group had no statistically significant difference(χ2= 0.013, P =0.909). In the observation group, the flap surrounding the mandible had a significant lower incidence of distal necrosis than that without surrounding the mandible, and the difference was statistically significant( χ2= 3.429, P = 0.044).1 years after the operation, the scar was softened, and there was no significant difference between the two groups. The mouth opening degree and buccal flap mucosal condition were ideal 1 year later, the difference was not statistically significant between the two groups(P > 0.05). Conclusion Platysma myocutaneous flap has good repairing effect for the preoperative defect in buccal cancer patients without dominant buccal and submandibular lymph node metastasis. It is especially suitable for the patients with missing teeth after resection of buccal lesions and patients who can not implement the free flap with high surgical risk. Compared with free flap, platysma myocutaneous flap has the advantages of small surgical trauma, good efficacy, simple operation and easy to carry out, its worthy of clinical promotion.