游离股前内侧嵌合穿支肌皮瓣在舌癌术后舌再造中的临床应用

Clinical application of free anteromedial thigh chimeric myocutaneous perforator flap in the reconstruction of tongue defect after resection of tongue carcinoma

目的探讨游离股前内侧嵌合穿支肌皮瓣在舌癌术后舌再造中的应用。方法2015年6月—2018年11月应用股前内侧嵌合穿支肌皮瓣对14例舌癌患者舌颌颈联合根治术后同期行舌及口底缺损修复,口底腔隙同时用不同来源肌瓣充填。肿瘤根治术后形成6.0 cm×4.0 cm^12.0 cm×7.0cm大小缺损,应用游离股前内侧嵌合穿支肌皮瓣修复,皮瓣面积为8.0 cm×4.0 cm^13.0 cm×8.0cm,肌瓣体积为4.0 cm×3.0 cm×2.0 cm^7.0 cm×5.0 cm×4.0 cm,术中将股前内侧穿支血管蒂的动脉与甲状腺上动脉吻合,伴行静脉与甲状腺上静脉或颈内静脉吻合。结果所有患者股前内侧穿支恒定存在,其中来源于股动脉主干7例(50%),血管蒂长度为(7.8±0.4)cm;来源于旋股外侧动脉主干4例(28.6%),血管蒂长度为(8.2±0.5)cm;来源于旋股外侧动脉降支3例(21.4%),血管蒂长度为(7.4±0.3)cm。肌瓣来源于股直肌为8例,肌瓣来源于股内侧肌为6例。其中8例血管蒂类型为1支动脉2支静脉,6例血管蒂类型为1支动脉1支静脉,甲状腺上静脉为首选的受区静脉,游离股前内侧穿支动脉伴行静脉与甲状腺上静脉端端吻合14例,其中8例的第2支伴行静脉另外与颈内静脉端侧吻合8例。术后皮瓣全部顺利成活,供区愈合良好。术后随访12~40个月,平均18.8个月,游离股前内侧穿支皮瓣修复舌外形不臃肿,两点辨别觉距离为8~15 mm,舌运动未见明显受限;大腿功能未见明显影响,可正常行走及进行相关日常活动。结论股前内侧嵌合穿支肌皮瓣是舌癌术后采用皮瓣移植再造舌的理想选择。

Objective To explore the clinical application of free anteromedial thigh chimeric myocutaneous perforator flap in the reconstruction of tongue defect after radical resection of tongue carcinoma.Methods From June 2015 to Nov 2018,14 cases with tongue carcinoma underwent radical resection with tongue and mouth floor defects reconstructed by free anteromedial thigh chimeric myocutaneous perforator flaps at the same stage.Defects after resection with size ranged from 6.0 cm×4.0 cm to 12.0 cm×7.0 cm were reconstructed by free anteromedial thigh chimeric myocutaneous perforator flaps with skin paddle size ranged from 8.0 cm×4.0 cm to 13.0 cm×8.0 cm and muscular segment ranged from 4.0 cm×3.0 cm×2.0 cm to 7.0 cm×5.0 cm×4.0 cm.All the arteries of the perforators were anastomosed with superior thyroid arteries,while the accompanying veins were anastomosed with superior thyroid veins or internal jugular veins.Results The perforators existed consistently in all cases.The perforator originated from femoral artery in 7 cases(50%)with an average pedicle length of(7.8±0.4)cm,from lateral femoral circumflex artery in 4(28.6%)with an average pedicle length of(8.2±0.5)cm,and from descending branch of lateral femoral circumflex artery in 3(21.4%)with an average pedicle length of(7.4±0.3)cm.Rectus femoris muscular flap was harvested in 8 cases,and vastus medialis muscular flap was harvested in 6.The pedicle vessels contained 1 artery and 2 accompanying veins in 8 cases,1 artery and 1 accompanying vein in 6,and the superior thyroid vein was the first choice of recipient vein.The first accompanying vein of perforator artery was anastomosed end-to-end with superior thyroid vein in 14 cases,while the second accompanying vein was anastomosed end-to-side with internal jugular vein in 8 cases.All flaps survived uneventfully 2 weeks after operation,and the wounds healed smoothly.All patients were followed up for 12 to 40 months after operation(18.8 months on average).The repaired sites were not bulky in appearance,with two-point discrimination distances ranged from 8 to 15 mm.The movement of tongue was not affected,and patients could speak and eat normally.The function of thigh was not affected obviously,and patients could walk normally and do related daily activities.Conclusion The free anteromedial thigh chimeric myocutaneous perforator flap is an idea choice to reconstruct the tongue defect after radical resection of tongue carcinoma.