4种带蒂皮瓣修复35例累及口角的颊部洞穿性缺损效果比较

Comparison of reconstruction outcomes of through-and-through buccal defects involving the labial commissure following tumor resection with 4 pedicled local flaps

目的:比较4种带蒂皮瓣修复累及口角的颊部洞穿性缺损的效果。方法 :35例累及口角的颊部鳞状细胞癌患者行根治性切除术后,采用4种带蒂皮瓣进行修复重建,4种皮瓣分别为交叉唇瓣(A-EF)、折叠延长锁骨上岛状皮瓣(SFIF)、折叠胸大肌肌皮瓣(PMMF)和折叠延长下斜方肌岛状皮瓣(TIMF)。比较4组患者修复重建后的效果,结果采用SPSS 20.0软件包进行统计学分析。结果:从美学角度,口轮匝肌功能以及发音功能比较,A-EF组显著优于其他3组(P<0.05)。在最后的随访中,A-EF组4例患者(80.0%)、SFIF组7例患者(87.5%)、PMMF组5例患者(55.6%)、TIMF组5例患者(38.4%)无严重术后并发症并存活;A-EF组1例患者(20.0%)、SFIF组1例患者(12.5%)、PMMF组2例患者(22.2%)、TIMF组4例患者(30.8%)带瘤生存;PMMF组2例患者(22.2%)和TIMF组4例患者(30.8%)于术后9~38个月分别死于原发灶复发或远处转移。结论:A-EF更适于临床Ⅱ期肿瘤术后缺损的修复重建;SFIF更适于临床Ⅱ期或Ⅲ期肿瘤患者;PMMF更适于临床Ⅲ期或Ⅳ期肿瘤患者;TIMF更适于临床Ⅲ期或Ⅳ期肿瘤患者。

PURPOSE:The purpose of this study was to evaluate the outcomes of reconstruction of through-and-through buccal defects involving the labial commissure following tumor resection with 4 pedicled local flaps.METHODS:This study evaluated 35 patients with buccal squamous cell carcinoma(SCC)involving the labial commissure who received Abbe Estlander(A-EF),folded extended supraclavicular fasciocutaneous island(SFIF),folded pectoral is major muscle(PMMF),or folded extended vertical lower trapezius island myocutaneous(TIMF)flap for reconstruction of through-and-through buccal defects.The results were analyzed with SPSS 20.0 software package.RESULTS:The A-EF and SFIF group differed significantly(P<0.05)from the PMMF and TIMF groups in terms of tumor clinical stage and type of treatment.The esthetic results,orbicularis oris function,and speech function were significantly better in A-EF group than in SFIF,PMMF,and TIMF group(P<0.05).At the final follow-up,4(80.0%)patients in A-EF group,7(87.5%)in SFIF group,5(55.6%)in PMMF group,and 5(38.4%)in the TIMF group were alive with no disease;one(20.0%),1(12.5%),2(22.2%),and 4(30.8%)patients,respectively,were alive with disease,and 2(22.2%)patients in PMMF group and 4(30.8%)in TIMF group died of local recurrence or distant metastases between 9 and 38 months.CONCLUSIONS:A-EF is suitable for reconstructing defects of clinical stage Ⅱ disease,SFIF for clinical stage Ⅱ or Ⅲ disease,PMMF for clinical stage Ⅲ or Ⅳ,and TIMF for clinical stage rCS Ⅲ or rCS Ⅳ disease.