股前外侧皮瓣在口腔颌面部肿瘤术后缺损修复中的应用效果研究

Study on Application Effects of Anterolateral Thigh Flap in Reconstruction of Oral and Maxillofacial Defects after Tumor Operation

目的:探讨股前外侧皮瓣在口腔颌面部肿瘤术后缺损修复中的效果及对皮瓣成活率的影响。方法:选择2018年1月-2021年1月笔者科室收治的92例经病理证实为口腔颌面部鳞状细胞癌并行扩大切除术+颈部淋巴清扫术和游离皮瓣修复术的患者为研究对象,根据修复皮瓣位置不同分为两组。对照组(前臂皮瓣修复)46例,观察组(股前外侧皮瓣修复)46例,比较两组患者皮瓣存活状况,比较术后1个月患者术区的充血程度、色泽、厚度、柔软度、顺应度及修复后功能恢复情况,记录两组患者术后并发症发生情况。结果:对照组皮瓣存活42例,成活率为93.54%,股前外侧皮瓣修复口腔颌面部缺损共存活44例,成活率为95.65%,差异无统计学意义(P>0.05)。术区瘢痕充血程度、色泽情况观察组好于对照组,术后患者满意度、外形修复、工作情况、口腔闭合、咀嚼、语言功能恢复观察组好于对照组,差异均有统计学意义(P<0.05)。对照组瘢痕增生(15.22%)、暂时性功能障碍(36.96%)、创源出血局部坏死(22.22%)发生率均高于观察组,差异有统计学意义(P<0.05)。结论:前臂皮瓣、股前外侧皮瓣在口腔颌面部缺损修复中均具有较好的皮瓣成活率,但是后者修复后并发症发生率更低。

Objective To investigate the effect of anterolateral thigh flap in the reconstruction of oral and maxillofacial tumors and its influence on the survival rate of flaps.Methods 92 patients who were admitted from January 2018 to January 2021 who were pathologically confirmed to be buccal squamous cell carcinoma with enlarged resection+neck lymphadenectomy and free skin flap repair were selected as the research objects,the control group(Repair of forearm flap)46 cases,observation group(repair of anterolateral thigh flap)46 cases,the survival status of flap was compared between the two groups;The degree of hyperemia,color,thickness,softness and compliance of the operation area 1 month after operation;Functional recovery after repair.The postoperative complications of the two groups were recorded.Results In the control group,42 cases survived,the survival rate was 93.54%,44 cases survived,the survival rate was 95.65%,the difference was not statistically significant(P>0.05).The degree of scar hyperemia and color in the observation group were better than those in the control group,and the patients’satisfaction,appearance repair,working condition,oral closure,chewing and language function recovery in the observation group were better than those in the control group,the difference was statistically significant(P<0.05).The incidence of scar hyperplasia(15.22%),temporary dysfunction(36.96%)and local damage of wound bleeding(22.22%)in the control group were higher than those in the observation group,and the difference was statistically significant(P<0.05).Conclusion Forearm flap and anterolateral thigh flap have good survival rate in the repair of oral and maxillofacial defects,but the complication rate of anterolateral thigh flap is lower.