不同形式游离股深动脉蒂嵌合穿支肌皮瓣修复舌癌术后缺损的疗效观察

Clinical application of various forms of free profunda femoral artery pedicled chimeric myocutaneous perforator flap in defect reconstruction after tongue carcinoma resection

目的探讨不同形式游离股深动脉蒂嵌合穿支肌皮瓣的临床解剖及其在舌癌术后缺损修复中的应用。方法 2011年4月—2016年1月,采用不同形式股深动脉蒂嵌合穿支肌皮瓣修复44例舌癌术后缺损。男40例,女4例;年龄32~71岁,平均46.3岁。原发舌缘24例,舌腹17例,口底癌累及舌3例。病理类型均为鳞状细胞癌;按国际抗癌联盟(UICC)TNM分期:T4N0M0 16例,T4N1M0 11例,T3N1M0 9例,T3N2M0 8例。病程1~22个月,平均8.6个月。皮瓣切取范围为8.5 cm×4.0 cm^12.0 cm×6.5 cm,肌瓣切取范围为4.0 cm×3.0 cm^7.5 cm×5.0 cm。其中11例采用游离股深动脉蒂嵌合穿支大收肌肌皮瓣,大收肌穿支血管蒂长度为(8.3±0.5)cm;33例采用游离股深动脉蒂嵌合穿支股薄肌肌皮瓣,股薄肌穿支血管蒂长度为(8.1±0.8)cm。大腿内侧供区均直接拉拢缝合。结果术后游离股深动脉蒂嵌合穿支肌皮瓣均顺利成活,创面Ⅰ期愈合;供区切口均Ⅰ期愈合。所有患者均获随访,随访时间12~40个月,平均23.8个月。所有患者再造舌形态良好,舌体活动可,吞咽和语言功能恢复满意,无1例肿瘤局部复发。大腿内侧瘢痕位置隐蔽,仅遗留线状瘢痕。结论游离股深动脉蒂嵌合穿支肌皮瓣可以以不同形式切取,适用于舌癌术后缺损修复。

Objective To investigate the clinical anatomy and application of free profunda femoral artery pedicled chimeric myocutaneous perforator flap in the defect reconstruction after radical resection of tongue carcinoma. Methods Between April 2011 and January 2016, 44 cases of tongue carcinoma underwent radical resection, and tongue defects were reconstructed by free profunda femoral artery pedicled chimeric myocutaneous perforator flaps at the same stage. There were 40 males and 4 females, with a mean age of 46.3 years （range, 32-71 years）. The pathologic type was squamous cell carcinoma, which involved the lingual margin in 24 cases, the ventral tongue in 17 cases, and the mouth floor in 3 cases. According to Union for International Cancer Control （UICC） TNM staging, 16 cases were rated as T4N0M0, 11 cases as T4N1M0, 9 cases as T3N1M0, and 8 cases as T3N2M0. The course of disease ranged from 1 to 22 months （mean, 8.6 months）. The size of perforator flap ranged from 8.5 cm×4.0 cm to 12.0 cm×6.5 cm, and the size of muscle flap ranged from 4.0 cmx3.0 cm to 7.5 cmx5.0 cm. The adductor magnus myocutaneous flap with a pedicle of （8.3±0.5） cm was used in 11 cases, and the gracilis muscle myocutaneous flap with a pedicle of （8.1±0.8） cm was used in 33 cases. The donor sites were sutured directly. Results All 44 perforator flaps survived uneventfully, and the donor site healed well. The patients were followed up for 12 to 40 months （mean, 23.8 months）. The reconstructed tongue had good appearance and function in swallowing and language. No local recurrence was found. Only linear scar was left at the donor sites. Conclusion The free profunda femoral artery pedicled chimeric myocutaneous perforator flap can be harvested in various forms, and is an ideal choice to reconstruct defect after radical resection of tongue carcinoma.