改良桡侧前臂游离皮瓣即刻修复口腔颌面部肿瘤根治术后缺损的临床观察

Clinical Observation on Modified Radial Forearm Free Flap for Immediate Repair of Defects after Radical Resection for Oral and Maxillofacial Tumors

目的:观察改良桡侧前臂游离皮瓣(RFFF)重建即刻修复口腔颌面部肿瘤根治术后缺损的临床疗效。方法:回顾性分析2014年4月-2018年4月孝感市中心医院口腔颌面外科收治的89例行口腔颌面部肿瘤根治术后缺损修复重建的患者临床资料,根据选择重建方式不同分为改良RFFF组(n=47)和传统RFFF组(n=42);比较两组一般情况、术后疗效及供区损伤情况。结果:两组皮瓣存活率均为100%。改良RFFF组较传统RFFF组皮瓣大小明显减小(P<0.05),两组手术时间、住院时间、经口进食时间无统计学差异(P>0.05)。术后3个月,改良RFFF组较传统RFFF组外形、工作与社交、患者满意度等评分均明显增高(P<0.05);而两组在饮食、口腔闭合、张口度、口腔纳水试验、咀嚼功能、咬合功能、吞咽功能及言语方面评分均无显著性差异(P>0.05)。改良RFFF组前臂术区感觉功能、桡神经浅支功能及前臂运动功能损伤程度均明显小于传统RFFF组(P<0.05)。结论:改良RFFF重建即刻修复口腔颌面部肿瘤根治术后缺损能够提高术区美观度及患者满意度,且对供区功能影响小。

Objective To observe the clinical curative effect of modified reconstruction of radial forearm free flap(RFFF)for immediate repair of defects after radical resection of oral and maxillofacial tumors.Methods The clinical data of 89 patients who underwent repair of defects after radical resection for oral and maxillofacial tumors in the hospital during the period from April 2014 to April 2018 were retrospectively analyzed.They were divided into the modified RFFF group(n=47)and the traditional RFFF group(n=42)according to the reconstruction method.The general condition,postoperative curative effect and injury at donor sites were compared between the two groups.Results The flap survival rate of both groups was 100%.Compared with the traditional RFFF group,the size of the flap was significantly smaller in the modified RFFF group(P<0.05).There was no significant difference in the surgical time,hospital stay or per-oral feeding time between the two groups(P>0.05).Scores of appearance,work and social contact and patient’s satisfaction in the modified RFFF group were significantly higher than those in the traditional RFFF group at 3 months after surgery(P<0.05).However,there was no significant difference between the two groups in the score of diet,mouth closure,mouth opening,oral water hold-up test,chewing function,occlusion function,swallowing function or speech(P>0.05).The damage to sensory function at surgical site of the forearm,function of the superficial branch of the radial nerve and the forearm motor function in the modified RFFF group was significantly milder than that in the conventional RFFF group(P<0.05).Conclusion Modified RFFF reconstruction can repair the defects after radical resection of oral and maxillofacial tumors and improve the aesthetic degree and patient’s satisfaction,with little effect on donor sites.