两种不同游离组织瓣在上颌组织缺损修复中的应用

Application of two different free tissue flaps in maxillary tissue defect reconstruction

目的评价游离前臂皮瓣及游离小腿后外侧穿支皮瓣修复上颌组织缺损的手术特点及临床效果。方法从2013年4月—2017年10月,共选取蚌医一附院口腔颌面外科接治的24例上颌部位恶性肿瘤患者,其中腭部鳞状细胞癌13例,腭部腺样囊性癌6例,上颌牙龈鳞状细胞癌4例,一侧未侵及眶底的上颌窦鳞状细胞癌1例。对其中的14例手术中即刻行游离前臂皮瓣修复,皮瓣切取的面积最大为7 cm×8 cm,最小为4 cm×5 cm。对其余10例行游离小腿后外侧穿支皮瓣的修复,皮瓣切取的面积最大为13 cm×9 cm,最小为5 cm×3 cm。术后分别随访评价2组患者组织缺损修复后外形,吞咽功能、语音功能和预后。结果术后2组共24例患者的游离皮瓣一次性成活22例,1例术后1 d后发生血管危象,经二次手术抢救后恢复,1例术后3 d发生血管危象,经抢救后仍坏死。术后供区、受区手术切口均Ⅰ期愈合。术后24例患者的外形的恢复,吞咽及语音功能均基本满意,2组之间差异无统计学意义。结论游离前臂皮瓣解剖位置恒定,制备方便,血管蒂长,可切取的量及长宽比例较为灵活,质地柔软菲薄,可以提供较大的软组织面积;可实施"双组手术"节约手术时间。游离小腿后外侧穿支皮瓣穿支血管的数量多,解剖位置恒定,管径较粗,血管壁弹性好,可携带神经一同移植,供区小腿皮肤可直接拉拢缝合。两种皮瓣在修复上颌部组织缺损中均能取得较满意的效果。

Objective To evaluate and analyze the surgical features and clinical effects of free forearm flap and free pos- terior lateral perforator flap in maxillary tissue defect. Methods From April, 2013 to October, 2017, 24 cases of malig- nant tumors in the maxillary region were treated with oral and maxillofacial surgery in the first affiliated hospital of Bengbu medical college, including 13 cases of squamous cell carcinoma of the palate, 6 cases of adenoid cystic carcinoma of the palate, 4 cases of squamous cell carcinoma of the maxillary gingiva, and 1 case of squamous cell carcinoma of the maxil- lary sinus that had no invasion of the orbital floor. And 14 of them were repaired with forearm free flap immediately after operation. The area of the flap was 7 cm × 8 cm and the smallest was 4 cm × 5 cm. The rest 10 cases were repaired with the free posterior lateral perforator flap. The largest area of the flap was 13 cm × 9 em and the smallest was 5 cm ×3 cm. The shape, swallowing function, voice function and prognosis of the two groups were evaluated after the operation. Re- suits After operation, there were 22 cases of free flap survival in 24 patients in two groups and 1 case of vascular crisis after one day after operation. After two operations, 1 case had vascular crisis on three days after the operation, and the number of necrotic cases was still contradictory after the rescue. After the operation, the donor area and the operative in- cision were all healed at I stage. After operation, the recovery of the 24 cases, the swallowing and voice function were ba- sically satisfactory, and there was no significant difference between the two groups. Conclusion The anatomical location of the free forearm flap is constant, the preparation is convenient, the pedicle of the blood vessel is long, the amount of cut and the length and width are flexible, the texture is soft and thin, the large soft tissue area can be provided, and the operation time can be saved by ＂double group operation＂. The posterior lateral perforator flap of the free leg has a large number of perforating vessels, a constant anatomical position, and thicker diameter of the tube, a good elastic wall, and a nerve graft with the nerve. The skin of the leg can be directly sutured. Two kinds of flaps can achieve satisfactory re- suits in repairing maxillofacial tissue defects.