髂骨-阔筋膜张肌复合组织瓣在下颌骨合并口腔软组织缺损修复重建中的应用

Application of vascularized iliac crest-tensor fascia lata flap in reconstruction of mandibular and oral soft tissue defects

目的探讨以旋髂深动静脉为血管蒂的髂骨-阔筋膜张肌复合组织瓣在下颌骨合并口腔软组织缺损修复重建中的应用效果。方法回顾性分析2020年10月至2022年3月河南省人民医院口腔颌面外科收治的下颌骨合并口腔软组织缺损患者的临床资料。所有病例术前均进行计算机辅助设计及三维打印制作模型及导板,应用以旋髂深动静脉为血管蒂的髂骨-阔筋膜张肌复合组织瓣进行修复重建,髂骨修复下颌骨缺损,阔筋膜张肌修复口内软组织缺损,将阔筋膜直接暴露于口腔内。术后严密观察患者口内移植组织瓣的颜色、质地、变化过程,对供、受区创面恢复及并发症发生情况进行随访。结果共纳入7例患者,男4例,女3例,年龄27~64岁,平均50.1岁。其中下颌牙龈及颊部鳞状细胞癌5例,下颌体多形性腺癌术后缺损1例,下颌骨成釉细胞瘤术后缺损1例。根据病变切除后软、硬组织的缺损范围,术中切取阔筋膜张肌组织瓣大小为6.0 cm×3.0 cm~8.0 cm×6.0 cm,髂骨瓣大小为3.7 cm×2.4 cm~9.2 cm×2.5 cm,术后复合组织瓣全部成活,未出现远端坏死、伤口延期愈合和边缘瘘口等情况。随访观察4~19个月,平均11.7个月,患者下颌骨及口腔软组织形态和功能均恢复良好,直接暴露于口腔内的阔筋膜张肌表面在术后1周内出现黏膜化征象,1个月左右黏膜化基本完成,接近口腔内正常黏膜形态,且后期可自行改建产生较好的口腔黏膜软组织形态;供区创面均愈合良好,下肢活动、大腿伸、屈功能均未见异常,其中3例患者术后3~5 d出现供区臀部股外侧皮肤麻木,随访6个月后2例麻木基本消失,1例明显减轻。结论以旋髂深动静脉为血管蒂的髂骨-阔筋膜张肌复合组织瓣用于下颌骨合并口内软组织缺损的修复重建,可获得较好的形态和功能,且并发症少,对供区损伤相对小。

Objective To evaluate the application effect of vascularized iliac crest-tensor fascia lata flap(VIC-TFLF)based on deep circumflex iliac artery and vein in mandibular and oral soft tissue defect reconstruction.Methods Retrospective analysis of the clinical data of patients with mandible and oral soft tissue defects in Henan Provincial People’s Hospital from October 2020 to March 2022.All cases were performed with computer-aided design and three-dimensional printing to make the models and guide plates.VIC-TFLF was used to repair and reconstruct the oral and mandible defects,the tensor fascia lata flap was used to repair the intraoral soft tissue defect,and the fascia lata was exposed to the mouth directly.After operation,the color,texture and change of intraoral flap were observed,and the recovery and complications were followed up.Results In this study,7 patients were included,4 males and 3 females,aged 27-64 years old,with an average of 50.1 years old.There were 5 cases of squamous cell carcinoma of mandible gingival and cheek,1 case of postoperative defect of pleomorphic adenocarcinoma of mandible,and 1 case of postoperative defect of ameloblastoma of mandible.According to the defect range of soft and hard tissue after resection,the flap areas of tensor fascia lata were 6.0 cm×3.0 cm-8.0 cm×6.0 cm,and the iliac bones were 3.7 cm×2.4 cm-9.2 cm×2.5 cm.All the composite tissue flaps survived,without distal necrosis,delayed wound healing and marginal fistula.The patients were followed up for 4-19 months,with an average of 11.7 months.The morphology and functions of the mandible and oral soft tissue were well recovered.The surface of tensor fascia lata was exposed to the oral cavity directly,which showed signs of mucosalization within 1 week after operation.The mucosalization was basically completed within 1 month,which was close to normal oral mucosal appearance,and could be reconstructed to produce better oral mucosal appearance in the later period.The wounds in the donor site healed well,and there was no abnormality in lower limb movement and thigh flexion.Among them,3 patients had numbness on the lateral thigh skin of the donor site 3-5 days after operation.After 6 months of follow-up,the numbness in 2 cases disappeared,and 1 case was significantly reduced.Conclusions The VIC-TFLF could obtain great appearance and function,with fewer complications and relatively small damage to the donor site,in repair and reconstruction of mandibular defects combined with oral soft tissue defects.