“简化”旋髂浅动脉穿支皮瓣在舌癌术后缺损修复中的应用

Application of "Simplified" Superficial Circumflex Iliac Artery Perforator Flap in Reconstruction of Defect after Radical Surgery of Tongue Cancer

目的:探讨仅解剖旋髂浅动脉(SCIA)浅支作为血管蒂的"简化"旋髂浅动脉穿支(SCIAP)皮瓣在舌癌术后缺损修复中应用的可行性及治疗效果。方法:6例舌癌患者术中制备SCIAP皮瓣时舍弃SCIA深支,仅解剖浅支作为皮瓣的血管蒂,并以之修复病灶切除术后的舌缺损。术后随访3~6月评价修复效果。结果:6例患者均存在SCIA浅支。切取SCIAP皮瓣的平均面积为41(24~54) cm~2,血管蒂平均长度为6.5(6.0~7.5) cm。SCIA浅支平均管径为0.9(0.5~1.2) mm,旋髂浅静脉平均管径为1.6(1.0~2.0) mm。5例SCIAP皮瓣修复成功,术后复查皮瓣形态佳,口腔功能恢复良好。1例因术中血管危象导致SCIAP皮瓣修复失败,术中更改为左前臂皮瓣修复舌缺损,并将SCIAP皮瓣修成全厚皮片修复前臂供区缺损。所有患者髂部术创拉拢缝合,均达成一期愈合,且术创瘢痕隐蔽。结论:“简化”的SCIAP皮瓣制备过程简单,足以胜任一般的舌癌术后缺损修复,且髂部供区瘢痕隐蔽,并发症少,具有一定的推广价值。

Objective: To explore the feasibility and therapeutic effect of "simplified" superficial circumflex iliac artery perforator(SCIAP) flap in reconstruction of defect after radical surgery of tongue cancer. Methods: The "simplified" SCIAP flap, which gave up the deep branch of SCIA and dissected superficial branch as pedicle, was applied to reconstruct the defect after radical surgery of tongue cancer in 6 patients. Patients were followed up for 3-6 months to finish the evaluation of repair effect. Results: Superficial branch of SCIA were found in all 6 patients. The average area of dissected flaps was 41(24-54) cm~2, and the average length of pedicle was 6.5(6.0-7.5) cm. The average diameter of superficial branch was 0.9(0.5-1.2) mm, while the average diameter of superficial iliac circumflex vein was 1.6(1.0-2.0) mm. Five patients achieved successful outcome with satisfying form of flap and good recovery of function such as phonetic and eating function. One patient ended with failure because of vascular crisis and replaced with left radial forearm free flap. Then, the skin paddle of SCIAP flap was fixed into full-thickness skin graft to repair the defect in forearm area. Wounds in iliac region were sutured directly and achieved primary healing with a hidden scar in all patients. Conclusion: "Simplified" SCIAP flap is easy to dissect, and it’s satisfying in reconstruction of defect after radical surgery of tongue cancer with a hidden scar of iliac region and low donor-site morbidity. It is worth to be popularized clinically.