颏下动脉穿支皮瓣修复口腔癌术后缺损的临床应用

Clinical application of submental artery perforator flap in oral and maxillofacial defect restoration after tumor resection

目的 探讨并总结颏下动脉穿支皮瓣（submental artery perforator flap,SMAPF）的临床解剖特点及手术技巧,评价其修复口腔癌术后缺损的肿瘤安全性及应用价值.方法 选择2014年1月至2017年3月于中南大学湘雅医院口腔颌面外科就诊的口腔癌患者56例,采用穿支皮瓣的制作技术,将传统的颏下岛状瓣改良为不携带二腹肌前腹及颏下淋巴脂肪组织的SMAPF修复口腔癌术后缺损,其中颊癌24例、舌癌21例、牙龈癌6例、口底癌3例、软腭癌2例.术中记录皮瓣大小、颏下动脉穿支和回流静脉的类型及数目.术后定期随访,重点评价皮瓣的修复效果及肿瘤安全性.结果SMAPF皮瓣大小为（3 cm×5 cm）^（5 cm×12 cm）.4例皮瓣静脉回流障碍,经针刺放血等保守治疗后完全解决;56例皮瓣存活率为100%.56例皮瓣中49例为颏下动脉肌间隔穿支皮瓣,7例为颏下动脉肌皮穿支皮瓣.回流静脉为颈外静脉、颈内静脉各28例.所有患者经3~41个月随访,无失访,患者舌运动和张口度均恢复良好,1例颊癌患者术后4个月局部复发.结论 SMAPF血运可靠,不携带二腹肌前腹和颏下淋巴脂肪组织,可为实现更好的肿瘤安全性提供技术基础,且功能和美学效果突出,可扩大颏下岛状瓣的适应证.

Objective To summarize the clinical anatomical features and surgical technique of the submental artery perforator flap（SMAPF）,and to evaluate the outcome and value of the flap for oral cavity reconstruction after cancer ablation.Methods A total of 56 patients with oral cancer were included in this study.The modified SMAPF excluded the anterior belly of the digastric muscle and submental fatty tissue. The primary sites of malignancy were buccal mucosa （n=24）, tongue （n=21）, mandibular gingiva （n=6）, mouth floor（n=3）,soft palate（n=2）.Results The flap size varied from 3 cm×5 cm to 5 cm×12 cm.Four flaps presented mild venous congestion, which was salvaged with conservative measures such as acupuncture and blood letting. Overall flap survival rate was 100%. The SMAPF with septocutaneous perforator was used in 49 cases and with musculocutaneous perforator in seven cases.External jugular vein and internal jugular vein provides venous drainage were applied in half cases respectively.All the patients showed a good recovery of tongue mobility and mouth opening with a follow-up of 3-41 months. Local recurrence was detected in one patient 4 months after operation. Conclusions The SMAPF is a reliable flap for oral cavity reconstruction with outstanding functional and aesthetic outcomes.