股前外侧游离皮瓣移植修复口腔颌面部肿瘤切除术后缺损

Anterolateral Thigh Free Flap Transplantation for Reconstruction of Postoperative Defects of Oral and Maxillofacial Tumors

目的:分析和研究采用股前外侧游离皮瓣移植修复口腔颌面部缺损的临床疗效。方法:回顾性分析2017年1月-2018年12月笔者医院收治的40例口腔颌面部缺损患者的临床资料,根据缺损部位进行股前外侧游离皮瓣移植修复,并统计临床治疗情况、疗效及预后。结果:40例患者,33例皮瓣一次成活,皮瓣成活率为95.00%,1例患者出现血运障碍,经抢救无效皮瓣坏死,1例患者因颈内静脉高压静脉回流受阻,改用胸大肌皮瓣修复;术后出现感染、口腔瘘及口腔积液各1例,并发症发生率为7.50%,经局部加压、切开引流及抗感染治疗后预后良好;术后随访6~12个月,缺损修复后语言及舌体功能尚可,形态丰满,张口度理想,可进普通饮食,但局部肌力下降食物易滞留,需清理;患者大腿供应区伤口均一期愈合,下肢感觉、负重和行走不受影响,且无局部复发者;患者满意度为90.00%。结论:对口腔颌面部缺损患者进行股前外侧游离皮瓣移植修复,其移植成活率高,并发症较低,且可塑性良好,是修复颌面部软组织缺损的理想游离皮瓣。

Objective To analyze and study the clinical situation and effect of repairing oral and maxillofacial defects with free anterolateral thigh flap.Methods The clinical data of 40 patients with oral and maxillofacial defects admitted to our hospital from January 2017 to December 2018 were analyzed retrospectively.According to the defect site,the free anterolateral femoral flap was transplanted and repaired,and the clinical treatment,curative effect and prognosis were counted.Results In 40 cases,33 flaps survived at one time,the survival rate of flap was 95.00%.One patient had blood circulation disorder,and the flap necrosis was invalid after rescue.One patient was repaired with pectoralis major myocutaneous flap because of the obstruction of internal jugular vein high pressure venous return.One patient had infection,one had oral fistula and one had mouth effusion,the complication rate was 7.50%.After the treatment of local pressurization,incision drainage and anti infection,the flap was pre treated After 6-12 months of follow-up,the language and tongue function were acceptable,the shape was plump,the mouth opening degree was ideal,and it could be fed into the common diet,but the food with local muscle strength decreased was easy to stay,and it needed to be cleaned;the wound in the thigh supply area of the patient healed in one stage,the feeling,weight and walking of the lower limbs were not affected,and there was no local recurrence;the patient satisfaction was 90.00%.Conclusion The transplantation of anterolateral femoral free flap for the patients with oral and maxillofacial defects has high survival rate,low complications and good plasticity,which is an ideal free flap for the repair of maxillofacial soft tissue defects.