游离胫后动脉穿支皮瓣与游离前臂桡侧皮瓣在修复头颈部缺损中的临床比较研究

Clinical comparative study of free posterior tibial artery perforator flap and radial forearm free flap for head and neck reconstruction

目的比较游离胫后动脉穿支皮瓣(free posterior tibial artery perforator flap,FPTF)和游离前臂桡侧皮瓣(radial forearm free flap,RFFF)在修复头颈部缺损方面的临床应用效果。方法回顾性分析2015年1月至2020年12月期间,首都医科大学附属北京同仁医院收治的27例使用FPTF(男性19例,女性8例,年龄14~69岁)和24例应用RFFF(男性11例,女性13例,年龄22~69岁)进行头颈部缺损修复患者的临床资料。对皮瓣大小、血管蒂长度、受区血管匹配程度、制备时间、总手术时间、住院时间、受区并发症和供区并发症等进行统计分析,并采用主观量表评估患者满意度。应用SPSS 26.0软件进行统计学分析。结果2组患者在肿瘤T分期和原发部位方面差异均无统计学意义(P值分别为0.38和0.05)。在皮瓣特征方面,FPTF的皮瓣面积与RFFF的差异无统计学意义[(53.67±29.84)cm^(2)比(41.13±11.08)cm^(2),t=-1.472,P=0.14],FPTF的血管蒂比RFFF的长,差异有统计学意义[(11.15±2.48)cm比(8.50±1.69)cm,t=-4.071,P<0.01]。FPTF组有4例患者的供区可直接缝合,而RFFF组24例患者均行供区皮肤移植。2组皮瓣的受区动脉差异无统计学意义(P=0.10),更倾向于面动脉(RFFF为21/24,FPTF为27/27);受区静脉上差异有统计学意义(P<0.01),RFFF组更倾向于颈外静脉(RFFF为14/24,FPTF为4/32),FPTF组更倾向于面后静脉(RFFF为9/24,FPTF为27/32)。在并发症方面,RFFF组出现10例受区并发症,3例供区并发症;FPTF组出现3例均为供区并发症。在术后12个月患者对供区的主观评价上,FPTF优于RFFF(χ^(2)=22.241,P<0.01)。结论FPTF是头颈部重建中RFFF的重要补充和另一种选择,在美学和临床应用等方面有其优势。

Objective To compare the clinical application results of the FPTF(free posterior tibial artery perforator flap)and RFFF(radial forearm free flap)for reconstruction of head and neck defects.Methods A retrospective analysis of 27 cases treated with FPTF(19 males and 8 females,aged 14-69 years)and 24 cases with RFFF(11 males and 13 females,aged 22-69 years)for head and neck defect reconstruction at Beijing Tongren Hospital of Capital Medical University from January 2015 to December 2020 was conducted.Flap size,vascular pedicle length,matching degree of recipient area blood vessels,preparation time,total operation time,hospital stay,recipient area complications,donor area complications and scale-based patient satisfaction were compared between two groups of patients with FTPF and RFFF.SPSS 26.0 statistical software was used for statistical analysis.Results There was no statistically significant difference between the two groups of patients in tumor T staging(P=0.38),primary sites(P=0.05)and mean flap areas((53.67±29.84)cm^(2) vs.(41.13±11.08)cm^(2),t=-1.472,P=0.14).However the mean vascular pedicle length of FPTF was more than that of RFFF((11.15±2.48)cm vs.(8.50±1.69)cm,t=-4.071,P<0.01).The donor sites of 4 patients in FPTF group could be sutured directly,while all the 24 patients in RFFF group received skin grafts from the donor sites.There was no statistically significant difference in the recipient area arteries between two groups of flaps(P=0.10),with more commonly using of the facial artery(RFFF:FPTF=21∶27),but there was significant difference in the recipient area veins(P<0.01),with more commonly using of the external jugular vein in RFFF(14/24)than FPTF(4/32)and the posterior facial vein in FPTF(27/32)than RFFF(9/24).There were 10 recipient complications and 3 donor complications in RFFF group;no recipient complication and 3 donor complications occurred in FPTF group.With patient′s subjective evaluation of the donor site at 12 months after surgery,FPTF was better than RFFF(χ^(²)=22.241,P<0.01).Conclusions FPTF is an alternative to RFFF in head and neck reconstruction and has unique advantages in aesthetics and clinical application.