股区穿支皮瓣在口腔颌面头颈部缺损修复的效果

Effects of thigh perforator flap on repair of oral and maxillofacial head and neck defects

目的探讨不同类型股区穿支皮瓣在口腔颌面头颈部缺损修复的临床经验。方法2018年1月至2021年1月,第四军医大学口腔医院颌面肿瘤科收集股区穿支皮瓣修复口腔颌面头颈部缺损患者573例,男317例、女256例,年龄18~75岁,平均61岁。根据穿支皮瓣类型将患者分为4组:股前外侧皮瓣组、股前内侧穿支皮瓣组、阔筋膜张肌穿支皮瓣组、游离肌瓣组。比较4组患者术后并发症发生率及创面愈合时间、术后股区负压引流量的差异。结果527例患者用股前外侧皮瓣修复,22例皮瓣术后出现血管危象,14例皮瓣出现感染,最终8例皮瓣坏死,519例皮瓣成活,创面愈合时间为(14.50±3.19)d,术后引流量为(49.9±21.3)ml;28例用股前内侧穿支皮瓣修复,2例皮瓣术后出现血管危象,1例皮瓣出现感染,最终皮瓣全部成活,创面愈合时间为(14.18±2.75)d,术后引流量为(50.3±23.0)ml;11例应用阔筋膜张肌穿支皮瓣修复,1例皮瓣术后出现血管危象,1例皮瓣出现感染,最终皮瓣全部成活,创面愈合时间为(14.09±2.66)d,术后引流量为(54.1±25.0)ml;7例用游离肌瓣修复,无血管危象及感染等术后并发症,且皮瓣全部成活,创面愈合时间为(14.14±1.86)d,术后引流量为(49.9±21.1)ml。573例各皮瓣类型患者术后在并发症发生率(皮瓣坏死、血管危象、感染等)及修复效果方面比较,差异均无统计学意义(均P>0.05)。术后随访6~24个月,供受区外观良好,平整,无明显瘢痕及功能影响;受区修复效果满意。结论股区穿支皮瓣虽然存在一定比例的穿支血管变异,可根据不同变异类型自由设计皮瓣。股区穿支皮瓣在口腔颌面头颈部缺损修复中有不可或缺的应用价值。

Objective To investigate the clinical experience of different types of femoral perforator flaps in the reconstruction of oral and maxillofacial head and neck defects.Methods From January 2018 to January 2021,573 patients with oral and maxillofacial head and neck defects reconstructed by femoral perforator flap were collected in the Department of Maxillofacial Oncology,the Third Affiliated Hospital of Air Force Military Medical University(age range of 21-76 years,with a male to female ratio of 1.23∶1).According to the type of perforator flap,the patients were divided into ALT group,AMT group,TFL flap group and free muscle flap group.The incidence of postoperative complications,wound healing time and drainage volume in femoral area were compared among the 4 groups.Results The ALT flap was used in 527 cases:22 flaps had vascular crisis,14 flaps had infection,8 flaps had necrosis,519 flaps survived;the mean healing time of the wound was(14.50±3.19)days,and the mean drainage volume was(49.9±21.3)ml.28 cases were repaired with AMT flap:2 flaps had vascular crisis and 1 had infection.All the flaps survived;the mean healing time of the wound was(14.18±2.75)days,and the mean drainage volume was(50.3±23.0)ml.11 cases were repaired by TFL flap:1 flap had vascular crisis and 1 had infection.All the flaps survived.The mean healing time of the wound was(14.09±2.66)days,and the mean drainage volume was(54.1±25.0)ml.7 cases were repaired by free muscle flap survived without vascular crisis,infection and other postoperative complications;the mean healing time of the wound was 14.14±1.86,and the mean postoperative drainage volume was(49.9±21.1)ml.There was no significant difference in complication rate(flap necrosis,vascular crisis,infection,etc.)and repair effect among 573 patients with different flap types.The postoperative follow-up was conducted for 6-24 months,and the donor area was smooth and good in appearance,without obvious scar or functional influence.The repair effect of the affected area was satisfactory.Conclusions Although there is a certain proportion of perforator vessel variation in the femoral perforator flap,the flap can be designed freely according to different types of variation.The thigh perforator flap has an essential application value in the repair of oral and maxillofacial head and neck defects.