游离小腿后外侧穿支皮瓣在口腔颌面部组织缺损修复重建中的应用

Clinial application of free posterlateral leg perforator flap in the reconstruction of soft tissue defects at oral and maxillofacial region

目的评价应用游离小腿后外侧穿支皮瓣修复口腔颌面部组织缺损的临床效果。方法从2014年2月到2016年8月，对16例口腔颌面部恶性肿瘤术后缺损患者即刻行游离小腿后外侧穿支皮瓣的修复，其中舌鳞状细胞癌3例．颊鳞状细胞癌6例，15底鳞状癌7例。游离皮瓣切取面积最大为13cm×9cm，最小为5cm×3cm。术后随访评价患者缺损组织修复的外形、患者开口度、吞咽功能、语音功能和预后。结果16例游离小腿后外侧穿支皮瓣均成活．1例发生血管（静脉）危象．经及时抢救后恢复正常。术中供区直接缝合，术后供、受区切口I期愈合．术后16例患者组织缺损区外形修复及患者开口度、语音功能均达到满意程度。结论游离小腿后外侧穿支皮瓣组织量丰富．血管较浅且恒定，设计灵活，不损伤知名血管腓动脉，是口腔颌面部组织缺损修复中较为理想的穿支皮瓣之一。

Objective To investigate the outcome of free posterolateral leg perforator flap in the reconstruction of soft tissue defects of oral and maxillofacial area. Methods From February, 2014 to August, 2016, 16 patients were performed defect reconstruction following oral cancer ablation with free posterolateral leg perforator flap including 3 cases of sequamous cell carcinoma of the tongue, 6 cases of carcinoma of the buccal mucosa,7 cases of sequamouse cell carcinoma of the floor of mouth. The flap ranged from 5.0 cm×3.0 cm to 13.0 cm ×9.0 cm in size, and were adjected to the soft tissue defects of oral and maxillofacial area. The outcome of reconstruction was evaluated by considering the facial appearance, the swallowing and the speach function, the ranges of mouth opening and patient prognosis. Results All 15 transplanted flaps survived well and only 1 survived after disposing in time, because of vascular crisis. The donor sites were closed directly without donor-site morbidity. All patients were satisfactory with their facial appearance, the ranges of mouth opening and swallowing and speech function. Conclusion The free posterolateral leg perforator was an ideal free tissue for repairing functionally oral and maxillofacial defects, sinceit including some beneficial characteristic such as constant blood vessel, flexible and divese design, abundant and position-latent donor site tissues, small operation loss, flexible preparation and loss of major vascular nerves.