游离胫后动脉皮瓣修复80例口腔颌面部软组织缺损效果评价

Application of posterior tibial artery flap in the reconstruction of oral and maxillofacial defects: Clinical analysis of 80 consecutive cases

目的:探讨胫后动脉皮瓣游离移植修复口腔颌面部软组织缺损的临床设计及效果。方法:2017年11月-2018年8月,应用胫后动脉皮瓣修复中山大学孙逸仙纪念医院收治的80例口腔颌面部肿瘤术后缺损。术前应用计算机体层血管成像(CTA)对双侧下肢血管进行评估,明确胫后动、静脉走向及穿支数量,完成穿支体表定位。术中根据受区部位、缺损大小、形态以设计、制备皮瓣,并转移至受区进行修复。对皮瓣大小、血管蒂长度、血管直径、穿支数量、穿支长度、存活率、外形、供区和受区术后并发症等进行总结分析。结果:80例患者中,男56例,女24例;年龄24~90(58.17±1.43)岁;皮瓣大小5 cm×6 cm^7 cm×13 cm,皮瓣厚度0.30~1.00(0.53±0.2) cm,血管蒂长度8~14(10.03±1.4) cm;供区动脉直径1.50~3.00(2.36±0.4) mm,供区静脉直径1.50~4.0(2.99±0.6) mm;穿支数量1~5(2.61±0.9)支(集中于小腿内侧中下1/3),穿支长度0.3~6(1.70±0.7) cm。皮瓣存活率为100%,伤口愈合良好。覆盖于小腿供区缺损处的皮片2例(2.5%)完全坏死,7例(8.7%)部分坏死,但经过换药处理后恢复满意。患者对外形及功能恢复满意。结论:应用胫后动脉皮瓣修复口腔颌面部缺损是一种较好的修复方式。胫后动脉皮瓣可携带近心端筋膜及皮下脂肪组织,用以丰满舌体形态、充填口底缺损、保护血管蒂。

PURPOSE: To explore the efficacy and design of posterior tibial artery flaps(PTAF) in the reconstruction of oral and maxillofacial defects. METHODS: Between November 2017 and August 2018, 80 patients underwent reconstruction of oral and maxillofacial defects with posterior tibial artery flaps. All of them received preoperative examinations with computed tomography angiography(CTA) to identify the course and perforators of the posterior tibial artery. During surgery, the designed and dissected PTAF was transferred to the recipient site and filled the defects. Data including the thickness and the size of the flap, length and diameter of the artery, number and length of perforators,survival rate of the flaps, complications at both the donor and recipient sites were collected and analyzed. RESULTS: Of 80 patients, 56 were male and 24 were female, ranging in age from 24-90(58.17±1.43) years. The flaps measured from 5 cm×6 cm to 7 cm×13 cm, the thickness of the flap was 0.30-1.00(0.53 ±0.2) cm, the pedicle length of the PTAF was 8-14(10.03±1.4) cm. The caliber of the posterior tibial artery was 1.50-3.00(2.36 ±0.4) mm, the caliber of the posterior tibial vein was 1.50-4.0(2.99±0.6) mm. The number of the septocutaneous perforator was 1-5(2.61±0.9) per leg, mostly clustered in the middle and distal thirds of the middle surface of the leg. The length of the perforators was 0.3-6(1.70 ±0.7)cm. All PTAF survived well. Skin graft was required in all cases for donor site of PTAF. Total loss of the skin graft occurred in 2/80(2.5%) of the patients. Partial loss of the skin graft occurred in 7/80(8.7%) of the patients, but all healed by conservative treatment. CONCLUTIONS: It’s an ideal choice to reconstruct oral and maxillofacial defect with PTAF. Also, caring the adipofascial extension is a better way to plump the form of the tongue, fill up the defect of the mouth floor and protect the vascular anastomosis from outer irritation.