延长下斜方肌皮瓣和胸大肌皮瓣修复复发口腔、口咽癌术后缺损的效果比较

Extended vertical lower trapezius island myocutaneous flap and pectoralis major myocutaneous flap used for reconstruction of patients with recurrent oral and oropharyngeal cancer

目的:比较延长下斜方肌皮瓣和胸大肌皮瓣在复发性口腔、口咽癌术后缺损重建中的应用效果。方法 :选取中山大学孙逸仙纪念医院口腔颌面外科39例复发口腔癌或口咽癌病例,挽救性手术切除后,以延长下斜方肌皮瓣或胸大肌皮瓣修复术后缺损,其中延长下斜方肌皮瓣修复21例,胸大肌皮瓣修复18例。采用SPSS 12.0软件包对数据进行统计学分析。结果:延长下斜方肌皮瓣可制备的血管蒂比胸大肌皮瓣更长,且延长下斜方肌皮瓣可制备的皮岛长度和宽度均大于胸大肌皮瓣。术后所有患者均未出现严重并发症,延长下斜方肌皮瓣比胸大肌皮瓣局部坏死几率更低。结论:延长下斜方肌皮瓣比胸大肌皮瓣蒂更长且皮岛面积更大,是修复复发口腔、口咽癌术后颌面部巨大缺损的最佳方法之一。

PURPOSE： To compare the use of extended vertical lower trapezius island myocutaneous flap（TIMF） and pectoralis major myocutaneous flap（PMMF） in reconstruction of large defect after radical surgery of advanced recurrent oral and oropharyngeal squamous cell carcinoma（SCC）. METHODS： A total of 39 patients with advanced recurrent oral and oropharyngeal SCC underwent salvage surgery followed by placement of either an extended lower vertical TIMF or PMMF for reconstruction. Twenty-one patients received extended lower vertical TIMFs, whereas 18 received PMMFs. SPSS12.0 software package was used for statistical analysis. RESULTS： The pedicle length of the TIMF was longer than that of the PMMF, and the skin paddle of the TIMF was both wider and longer than the PMMF. No major complications developed in any of the patients. The TIMF group experienced a lower rate of minor flap failure than the PMMF group.CONCLUSIONS： Extended vertical lower TIMF, which has a longer pedicle flap and a larger skin paddle than a PMMF,is an optimal flap for reconstruction of major defects.