前臂皮瓣与股前外侧皮瓣修复口腔颌面部缺损的效果比较

Comparison of forearm flap and anterolateral thigh flap in reconstruction of oral and maxillofacial defects

目的 :比较分析前臂皮瓣和股前外侧皮瓣修复重建口腔颌面部肿瘤术后缺损的临床效果。方法 :收集54例行口腔颌面部恶性肿瘤根除术并接受游离皮瓣修复术的患者资料,其中33例患者采用前臂皮瓣修复(A组)、21例采用股前外侧皮瓣修复(B组)。应用SPSS 19.0软件包分析2组患者的手术持续时间、皮瓣存活率、受区功能与外形恢复情况、供区恢复情况及患者满意度等。结果:A组手术时间为(41.6±8.9)min,B组为(47.2±10.2)min,差异具有统计学意义(P<0.05);A组皮瓣存活率(93.9%)高于B组(90.5%),但差异无显著性(P>0.05);受区功能与外形恢复情况2组基本相似;供区功能恢复B组优于A组,A组永久性功能障碍比率为24.2%,B组仅有暂时性功能障碍且比率为9.5%;A组供区色素沉着发生率显著高于B组(P<0.05);B组的满意度显著优于A组(P<0.05)。结论 :应用前臂皮瓣与股前外侧皮瓣修复,术后受区功能、外形恢复情况相似。前臂皮瓣成功率高,但需要植皮,且术后供区易形成永久性功能障碍;股前外侧皮瓣供区隐蔽,可以提供的组织量大,术后供区功能障碍很少,患者满意度高,但是手术难度大于前臂皮瓣,技术要求高。

PURPOSE： To compare and analyze the clinical effectiveness of forearm flap and anterolateral thigh flap in reconstruction of oral and maxillofacial defects. METHODS： Fifty-four cases undergoing oral and maxillofacial defect reconstruction with forearm flap and anterolateral thigh flap were reviewed. Thirty-three cases used forearm flap（group A）,and 21 cases used anterolateral thigh flap after tumor resection. Operative duration, survival rate of flap, shape changes of recipient site, donor site and patients＇ satisfaction were analyzed between 2 groups with SPSS 19.0 software package.RESULTS： The operative duration of group A was（41.6±8.9） min,（47.2±10.2） min in group B, and the difference was statistically significant（P〈0.05）. Flap survival rate was 93.9% in group A and 90.5% in group B, the difference was not statistically significant（P〈0.05）. Shape changes of recipient site in group A were similar to group B. Donor site recovery was better in group B. The rate of permanent dysfunction in group A was 24.2% and 0 in group B, and the rate of temporal dysfunction was 9.5% in group B. CONCLUSIONS： Forearm flap was as useful as anterolateral thigh flap in reconstruction of postoperative defects of oral and maxillofacial tumors. In clinical practice, advantages and disadvantages should be considered according to individual conditions in selection of free flaps.