前臂皮瓣与股前外侧皮瓣修复口腔癌术后缺损临床研究

Clinical Research on Forearm Flap and Anterolateral Thigh Flap for Reconstructing Postoperative Defects of Oral Cancer

目的:探讨前臂皮瓣与股前外侧皮瓣在修复口腔癌术后缺损的效果。方法:收集2015年5月～2018年3月因口腔癌在中南大学湘雅口腔医院口腔颌面外科诊治,进行了游离皮瓣移植修复的患者60例,其中前臂皮瓣16例,股前外侧皮瓣44例。术后观察并记录皮瓣成活情况,供区恢复情况及口腔颌面部受区功能及形态。结果:60例游离皮瓣总成活率为90.0%(54/60),前臂皮瓣成活率为87.5%(14/16),股前外侧皮瓣成活率为90.9%(40/44),两组皮瓣存活率比较,差异无统计学意义(P>0.05)。术后随访6～36个月,皮瓣修复效果满意。两组皮瓣术前与术后至少6个月的生存质量评分比较,差异均有统计学意义(P<0.05)。两组皮瓣术后生存质量评分比较,差异无统计学意义(P>0.05)。前臂皮瓣组供区中仅2例出现瘢痕增生,股前外侧皮瓣组供区无明显后遗症。结论:前臂皮瓣与股前外侧皮瓣均具有移植成活率高、对颌面部外形及功能恢复效果佳等优点,可作为修复口腔癌术后缺损的主力皮瓣。

Objective: To explore the contributions of anterolateral thigh flaps and forearm flaps in the reconstruction of defects caused by oral cancer resection.Methods: Sixty patients who were conducted free flap transfers on account of oral cancer operations,from May 2015 to March 2018,were reviewed by Oral and Maxillofacial Surgery of Xiangya Stomatological Hospital.The reconstruction cases contained 44 anterolateral thigh flaps and 16 forearm flaps.The survival conditions of free flaps,the recovering states of donor sites and the shapes and functions of receiving sites were closely observed and recorded.Results: The overall survival rate of free flaps was 90.0%(54/60),and those of forearm flaps and anterolateral thigh flaps were 87.5%(14/16) and 90.9%(40/44),respectively.The difference between two groups was not statistically significant (P>0.05).After a 6 to 36 months follow-up observation,the restoration effects were mostly satisfied.The difference of survival quality score before and after operation in two groups was statistically significant,respectively (P<0.05).The difference of survival quality score between two groups was not statistically significant (P>0.05) at least 6 months after surgery.Only 2 patients,who were repaired by forearm flaps,showed distinct scars in donor sites while no complications were observed in the patients repaired by anterolateral thigh flaps.Conclusion: Both anterolateral thigh flap and forearm flap have the superiority of survival rate,shape and functional recovery in lesion.Therefore,they are optimistic choices for repairing defects caused by oral cancer.