围裙式颈阔肌肌皮瓣在口腔颌面部缺损修复中的应用

Application of platysma myocutaneous flap with apron incision in the restoration of oral and maxillofacial defects

目的:介绍一种新颖的颈阔肌肌皮瓣术式,评价其修复口腔颌面部缺损的应用价值。方法:用围裙式颈阔肌肌皮瓣修复口腔颌面部病变切除术后缺损的患者15例。设计U形的围裙式切口制备皮瓣,保留蒂部皮肤,加宽肌蒂宽度。结果:15例围裙式颈阔肌肌皮瓣12例完全成活,3例皮瓣部分坏死。其中,修复颊黏膜、舌、牙槽突缺损的皮瓣完全成活率分别为8/9、1/3、3/3。另有2例颈部供区伤口愈合不良。所有病例经4~33个月随访,1例牙龈癌颈部瘢痕较为明显,1例舌癌舌运动受限,其余病例口腔颌面部形态、功能恢复良好。结论:和颈阔肌肌皮瓣比较,围裙式颈阔肌肌皮瓣可提供更宽的皮岛,特别适合中小型颊部软组织及牙槽突缺损的修复,舌部缺损不是该皮瓣最佳适应证。

Objective： To introduce a new style of platysma myocntaneous flap and to evaluate its application value in the restoration of oral-maxiofacial defects. Methods： Platysma myocutaneous flap with apron incision was used for the restoration of oral-maxiofacial defects after oral lesion ablation in 15 cases from January, 2014 to September, 2015. The platysma muocutaneous flap was harvested with a U shaped apron incision. The skin above the flap pedicle was preserved. The platysma pedicle was widened to ensure the flap survival. All the patients were followed up form 4 to 33 months. Results： Of the 15 platysma myecutaneous flaps,12 survived com- pletely and 3 had partial flap necrosis. The total survival rate of the flaps at the recipient site of buceal mucosa, tongue and alveolar was 8/9, 1/3 and 3/3 respectively. Additionally,there were 2 cases of disturbed wound healing in the neck. Except for 1 case of carcinoma of gingiva which had apparent cervical scar and 1 case of tongue carcinoma which had limited tongue mobility, the other cases showed a satisfactory recovery of oral-maxillofacial contour and fucnction. Conclusion： Compared with the traditional platysma myocutaneous flap, the platysma myocutaneous flap with apron incision can provide a larger skin paddle, and is suitable for the restoration of small and medium sized huccal mucosa and alveloar defects,but not for tongue defect.