折叠横形腹壁浅动脉穿支皮瓣修复颊癌术后大面积洞穿性缺损

Application of folded transverse superficial epigastric artery perforator flap for large penetrating defect after buccal carcinoma resection

目的探讨折叠横形腹壁浅动脉穿支皮瓣修复颊癌术后大面积洞穿性缺损的疗效。方法2019年1月—2021年6月,收治12例颊部鳞状细胞癌患者。男6例,女6例;年龄53~79岁,平均66.9岁。病理分期为T3a~T4b,术前张口度为(3.08±0.46)cm。病程6~24个月,平均15个月。经颊癌根治性切除术、颈部淋巴结清扫术后,缺损范围8 cm×6 cm~16 cm×8 cm,深度0.5~1.5 cm;设计并切取腹壁浅动脉穿支皮瓣(8 cm×6 cm~14 cm×8 cm)折叠后修复洞穿性缺损。供区直接拉拢缝合。结果术后12例皮瓣均成活,创面Ⅰ期愈合;无口腔内、外瘘并发症发生。受区切口均Ⅰ期愈合。患者均获随访,随访时间12~18个月,平均14个月。皮瓣颜色、质地未见明显异常,口腔、面部外观对称,颊部无明显臃肿。末次随访时患者张口度为(2.89±0.33)cm,与术前比较差异无统计学意义(t=1.879,P=0.087)。患者主观满意度评分为6~8分,平均7.3分。供区遗留明显瘢痕但位置隐蔽。结论折叠横形腹壁浅动脉穿支皮瓣修复颊部大面积洞穿性缺损,术后患者面部外观及口腔功能恢复较好,可作为颊癌术后修复术式。

Objective To explore the effectiveness of folded transverse superficial epigastric artery perforator flap in repairing the large penetrating defect after buccal carcinoma resection.Methods Between January 2019 and June 2021,12 patients with buccal squamous cell carcinoma were treated.There were 6 males and 6 females with an average of 66.9 years(range,53-79 years).The pathological stage was T3a-T4b,and the preoperative mouth opening was(3.08±0.46)cm.The disease duration ranged from 6 to 24 months,with an average of 15 months.After buccal carcinoma radical resection and neck lymph node dissection,the penetrating defects in size of 8 cm×6 cm to 16 cm×8 cm and in depth of 0.5-1.5 cm were remained.The transverse superficial epigastric artery perforator flap in size of 8 cm×6 cm to 14 cm×8 cm were harvested and folded to repair the penetrating defects.The donor site was sutured directly.Results All 12 skin flaps survived after operation,and the wounds healed by first intention.No internal or external fistula complications occurred.All incisions at the recipient site healed by first intention.All patients were followed up 12-18 months(mean,14 months).There was no obvious abnormality in the color and texture of the flap,the oral and facial appearances were symmetrical,and there was no obvious swelling in the cheek.At last follow-up,the patient’s mouth opening was(2.89±0.33)cm,which was not significantly different from that before operation(t=1.879,P=0.087).The subjective satisfaction scores of 12 patients were 6-8 points,with an average of 7.3 points.Significant scars remained at the donor site but concealed in location.Conclusion The folded transverse superficial epigastric artery perforator flap can be used as a surgical method for repairing large penetrating defects after the buccal carcinoma resection,with a good recovery of facial appearance and oral function.