股直肌瓣和股前外侧肌瓣的应用解剖及其修复口腔恶性肿瘤术后缺损

Anatomy of rectus femoris muscle flap and anterolateral thigh muscle flap and their application in reconstruction of postoperative defects of oral malignant tumour

目的探讨股直肌瓣和股前外侧肌瓣的应用解剖及其在修复口腔恶性肿瘤切除术后较大软组织缺损中的临床效果。方法2006年12月至2009年6月,昆明医科大学基础医学院对8具经10%甲醛固定的中国成年人标本行股前外侧区域的解剖,用Image-Pro Plus 6.0软件对解剖图片进行分析。对2020年3月-2022年7月昆明医科大学附属口腔医院使用股直肌瓣和股前外侧肌瓣修复口腔恶性肿瘤切除术后缺损的19例患者进行回顾性分析。19例口腔恶性肿瘤患者切除术后缺损面积3.0 cm×6.0 cm~5.0 cm×10.0 cm。其中应用股直肌瓣10例、股前外侧肌瓣8例、股直肌瓣和股前外侧肌瓣联合肌瓣1例,切取肌瓣面积4.0 cm×8.0 cm~6.0 cm×11.0 cm。术后门诊定期随访。结果制备的股直肌瓣和股前外侧肌瓣血管蒂长度分别为(63.4±12.9)mm和(112.5±19.6)mm,旋股外侧动脉、旋股外侧动脉斜支、旋股外侧动脉降支起始外径分别为(2.92±0.72)mm、(1.88±0.23)mm和(2.29±0.43)mm。本组门诊随访时间为7~32个月,平均17.5个月;17例完全成活,术后5周股直肌瓣完全黏膜化,余2例股直肌瓣完全坏死,1例改为舌瓣修复,另1例术后放疗过程中坏死,清创后多次换药愈合;供区无术后肢体运动及感觉障碍并发症。结论股直肌瓣和股前外侧肌瓣血管的外径和血管蒂长度满足颌面部缺损修复的需要,两种肌瓣制备简单,修复效果好,并发症少,是修复口腔恶性肿瘤术后较大软组织缺损的可行方案。

Objective To investigate the anatomy of rectus femoris muscle flap and the anterolateral thigh muscle flap and their clinical application in reconstruction of large soft tissue defects after the removal of oral malignant tumour.Methods From December 2006 to June 2009,8 specimens of Chinese adult cadavers fixed in 10%formaldehyde were dissected to perform anatomy of anterolateral thigh region at the School of Basic Medical Sciences,Kunming Medical University.Anatomical images were analysed using Image-Pro Plus 6.0.Then,a retrospective study was performed on 19 patients who had postoperative defects after oral malignant tumour surgery and the defects were reconstructed with the rectus femoris muscle flap and the anterolateral thigh muscle flap from March 2020 to July 2022 at the Department of Oral and Maxillofacial Surgery,Affiliated Stomatology Hospital,Kunming Medical University.The postoperative defects of the 19 patients ranged from 3.0 cm×6.0 cm to 5.0 cm×10.0 cm.Ten rectus femoris muscle flaps,8 anterolateral thigh muscle flaps and 1 combined rectus femoris muscle flap and anterolateral thigh muscle flap were used.The muscular flaps sized from 4.0 cm×8.0 cm to 6.0 cm×11.0 cm.Regular postoperative outpatient follow-ups were conducted.Results The lengths of vessels of the harvested rectus femoris muscle flap and anterolateral thigh muscle flap were 63.4 mm±12.9 mm and 112.5 mm±19.6 mm,respectively.The starting outer diameters of the lateral circumflex thigh artery,the oblique branch of the lateral circumflex thigh artery and the descending branch of the lateral circumflex thigh artery were 2.92 mm±0.72 mm,1.88 mm±0.23 mm and 2.29 mm±0.43 mm,respectively.Postoperative follow-up lasted for 7 to 32 months,with 17.5 months in average.Seventeen flaps were completely survived and the rectus femoris muscle flap was completely mucosalised 5 weeks after surgery.However,2 rectus femoris muscle flaps had necrosis of which one was changed to a tongue flap reconstruction and the other encountered flap necrosis during postoperative radiotherapy and healed after debridement and dressing changes.There was no postoperative complication in the donor sites.Other than the 2 patients,all other 17 patients had satisfactory clinical outcomes.Conclusion Both of the starting outer diameters and length of vessels of the femoris muscle flap and the anterolateral thigh muscle flap meet the requirements for reconstruction of maxillofacial defects,and both muscular flaps are simple to prepare,in good reconstructive results with few complication,as well as an excellent outcome.They are feasible approaches for reconstruction of large soft tissue defects left after the removal of an oral malignant tumour.