应用颏下岛状瓣修复口腔癌术后缺损

Submental island flap for repairing oral defect after radical resection of oral cancer

目的总结颏下岛状瓣的制备技巧及修复口腔癌术后缺损的临床效果。方法回顾性分析2015年1月—2017年5月应用颏下岛状瓣修复口腔癌术后缺损的患者25例,总结颏下岛状瓣的静脉回流特点、手术技巧和术后并发症。通过随访分析颏下岛状瓣修复口腔癌术后缺损的安全性。结果皮瓣切取大小为(5 cm×3 cm)^(12 cm×5 cm),平均手术时间(350.5±50.5)min。皮瓣通过面前静脉回流至颈内静脉17例(68.0%)、颈外静脉4例(16.0%)、颈前静脉4例(16.0%)。除1例因术中损伤颏下动脉弃去皮瓣外,其余24例均完全成活。术后1例发生伤口感染,其余24例伤口均一期愈合。术后8例(32.0%)证实颈部淋巴结转移,其中4例为颌下淋巴结转移,Ⅰ区淋巴结转移率为16.0%。平均随访(14.3±5.2)个月,1例原发灶复发,2例颈部复发,均为术后未放疗患者。结论颏下岛状瓣的静脉回流方式存在变异,制备皮瓣时应特别注意回流至颈外静脉和颈前静脉的情况,以避免回流障碍及皮瓣坏死。对于术后颈部淋巴结阴性的患者,应密切随访或辅助放疗,警惕皮瓣及血管蒂周围淋巴结转移的风险。

Objective To summarize the surgery skills and evaluate the clinical outcome of submental island flap forrepairing oral defect after radical resection of oral cancer.Methods A total of 25 consecutive patients underwentsubmental island flap reconstruction after ablative surgery for oral cancer from January 2015 to May 2017 were enrolled inthis study.The patterns of venous return,the technique notes and postoperative complications were summarized.Theoncological safety of submental island flap in oral reconstruction was analyzed.Results The submental island flaps wereharvested with the sizes ranging from（5 cm×3 cm） to（12 cm×5 cm）.The mean operation time was（350.5±50.5） min.Thevein of the flap was found to drain into the facial vein,and then returned to the internal jugular vein in 17 patients（68.0%）,into the external jugular vein in 4 patients（16%）,and into the anterior jugular vein in 4 patients（16%）.Twenty-four flapssurvived completely,and 1 flap failed due to the damage of the submental artery.Wound infection occurred in only 1 patient,and primary wound healing was observed in the other 24 patients.Eight patients（32.0%） with cervical lymph nodemetastases were verified by the postoperative pathological examination,4 patients were submandibular lymph nodemetastases.The prevalence of occult lymph node metastasis involving level Ⅰ was 16.0%.The mean follow-up period was（14.3 ± 5.2） months.Local recurrence was found in 1 patient and cervical recurrence in 2 patients without postoperativeradiotherapy during the follow-up.Conclusion There are three various drainage patterns for the venous return of submental island flap.Our data suggest that vein drainage of the flap into the external jugular vein and the anterior jugularvein,which are previously overlooked,should receive greater attention during the harvest of submental flap to avoid venouscongestion and flap loss.Close follow-up or postoperative radiotherapy are recommended for patients without cervical lymphnode metastases.