股前内侧接力穿支皮瓣修复游离股前外侧穿支皮瓣供区的临床应用

Clinical application of relaying anteromedial thigh perforator flap in resurfacing of donor defect after anterolateral thigh flap transfer

目的探讨股前内侧接力穿支皮瓣修复游离股前外侧穿支皮瓣供区的临床疗效。方法 2012年2月—2015年12月,收治23例口腔癌患者。其中男21例,女2例;年龄29~74岁,平均52.6岁。舌鳞状细胞癌16例,口颊癌7例。肿瘤TNM分期:T4N0M03例,T4N1M0 5例,T3N1M0 7例,T3N2M0 5例,T3N0M0 3例。病程6~18个月,平均8.8个月。行颈淋巴清扫和原发病灶根治性切除术后,采用游离股前外侧穿支皮瓣行口腔缺损修复,供区采用股前内侧接力穿支皮瓣移位修复。结果所有患者均确认有恒定的股前内侧穿支存在,未发现穿支缺如。术后所有皮瓣均顺利成活,供受区创面均Ⅰ期愈合。未发生血管危象、伤口裂开和明显肿胀等情况。23例均获随访,随访时间6~20个月,平均9.4个月。皮瓣供区仅遗留线性瘢痕,大腿功能未见明显影响,颜色及外观轮廓自然。结论股前内侧接力穿支皮瓣是修复游离股前外侧穿支皮瓣供区的理想选择。

Objective To investigate the clinical application of relaying anteromedial thigh （AMT） perforator flap in resurfacing of the donor defect after anterolateral thigh （ALT） flap transfer, Methods Between February 2012 and December 2015, 23 cases of oral carcinoma underwent radical resection; after resection of lesions, the tongue or mouth floor defects were reconstructed by ALT perforator flaps, and the donor sites were repaired with relaying AMT perforator flap at the same stage. There were 21 males and 2 females,with a mean age of 52.6 years （range, 29-74 years）. Sixteen patients had tongue squamous cell carcinoma and 7 patients had buccal cancer. According to TNM tumor stage, 3 cases were classified as T4N0M0, 5 cases as T4N1M0, 7 cases as T3N1M0, 5 cases as T3N2M0, and 3 cases as T3N0M0. The disease duration ranged from 6 to 18 months （mean, 8.8 months）. Results The AMT perforators existed consistently in all patients. All flaps survived, and primary healing of wounds was obtained at recipient sites and donor sites. No vascular crisis, wound dehiscence, or obvious swelling occurred. All patients were followed up 6-20 months （mean, 9.4 months）. There was only linear scar at the donor sites, and the function of thighs was normal. The color and contour of the flaps were satisfactory. Conclusion The relaying AMT perforator flap is an ideal choice to reconstruct the donor site of ALT flap.