带蒂穿支皮瓣修复口腔颌面部软组织缺损临床研究

Clinical study of pedicled perforator flaps in repairing oral maxillofacial soft tissue defects

目的探讨带蒂穿支皮瓣修复口腔颌面部软组织缺损的可行性并评价其临床效果。方法 2014年10月至2016年12月,采用5种带蒂穿支皮瓣对中南大学湘雅医院口腔颌面外科62例患者口腔颌面部肿瘤根治术后软组织缺损进行修复,其中颏下动脉穿支皮瓣34例、甲状腺上动脉穿支皮瓣16例、面动脉穿支皮瓣10例、胸廓内动脉穿支皮瓣1例、胸廓内动脉穿支皮瓣与胸肩峰动脉穿支皮瓣联合应用1例。缺损部位为舌26例、颊18例、口底9例、牙龈7例、颈根部2例。详细记录各种皮瓣的临床解剖学特征、制备要点及并发症的发生情况。结果 61例皮瓣成活,1例甲状腺上动脉穿支皮瓣坏死。术中发现皮瓣穿支血管解剖位置基本恒定,制作简单、耗时少。修复后皮瓣色泽、质地满意。供区无明显瘢痕增生,颈部活动未受影响。随访8个月至2年,所有患者均未见局部或颈部淋巴结复发。结论带蒂穿支皮瓣制备简单,应用灵活,克服了传统局部带蒂皮瓣的长宽比例与转移角度受限的缺点,且无需血管吻合,手术时间短,可用于口腔颌面部中小型软组织缺损的修复。

Objective To investigate the feasibility of pedicled perforator flaps in repairing oral and maxillofacial soft tissue defects and assess the clinical application effects.Methods From October,2014 to December,2016,a total of 62 patients with oral and maxillofacial soft tissue defects after cancer ablation were repaired with pedicled perforator flaps,including submental artery perforator flaps in 34 cases,superior thyroid artery perforator flaps in 16 cases,facial artery perforator flaps in 10 cases,internal mammary artery perforator flap in 1 case,and thoracoacromial artery perforator flap combined with internal mammary artery perforator flap in 1 case.The defect sites included tongue in 26 cases,buccal in 18 cases,mouth floor in 9 cases,gingival in 7 cases and neck in 2 cases.The clinical anatomical features,harvesting key points and complications of each kind of flaps were recorded in detail.Results All flaps survived,except for 1 case of superior thyroid artery perforator flap,which ended with necrosis.During operation,the flaps could be harvested easily in a short time with stable site and simple operation.The color and texture of flaps were satisfactory.The donor site was closed directly without formation of hypertrophic scar and the movement of neck was not affected.All patients were followed up for 8 months to 2 years,and no local or regional cancer recurrence happened.Conclusion The pedicled perforator flaps have various advantages,such as adjacent donor site,simple preparation process,short-time operation,dispensing with microvascular anastomosis,and also overcome the disadvantages of limited distance and rotation arc of the traditional local pedicled flaps,which have tremendous application value in repairing snall to middle size soft tissue defects in oral and maxillofacial region.