游离背阔肌皮瓣修复口腔颌面部巨大软组织缺损38例临床效果观察

Clinical effect of free latissimus dorsi flap in repairing large soft tissue defects of oral and maxillofacial region in 38 cases

目的 探讨游离背阔肌皮瓣在修复口腔颌面部巨大软组织缺损中的临床应用效果。方法 选择2020年9月至2022年9月于首都医科大学附属北京口腔医院口腔颌面头颈肿瘤科因口腔颌面部恶性肿瘤切除术行游离背阔肌皮瓣修复口腔颌面部巨大软组织缺损患者38例(男26例、女12例),其中牙龈癌11例、舌及口底癌10例、颊黏膜癌10例、中央性颌骨癌2例、上颌窦癌3例、口咽癌2例。根据肿瘤切除后的缺损范围制取背阔肌皮瓣,最大切取面积为12.0 cm×24.0 cm,供区拉拢缝合。观察术后皮瓣成活情况,随访观察供区和受区恢复情况及肿瘤复发情况。结果 38例患者的游离背阔肌皮瓣全部成活,供区和受区创口均Ⅰ期愈合。术后随访6~24个月,背阔肌皮瓣及供区均恢复良好;其中3例患者出现术后肿瘤复发,予以二次手术治疗。结论 应用游离背阔肌皮瓣可有效修复口腔颌面部恶性肿瘤切除后的巨大软组织缺损,值得临床推广应用。

Objective To investigate the clinical effect of free latissimus dorsi flap in the repair of large soft tissue defect in oral and maxillofacial region.Methods From September 2020 to September 2022,38 patients with large soft tissue defect in oral and maxillofacial region,26 males and 12 females,were admitted for treatment in Department of Oral and Maxillofacial-Head and Neck Oncology of Beijing Stomatological Hospital.All patients were repaired with free latissimus dorsi flap.And among them,there were 11 cases of gingival carcinoma,10 cases of tongue and mouth floor carcinoma,10 cases of buccal mucosa carcinoma,2 cases of central jaw bone carcinoma,3 cases of maxillary sinus carcinoma,and 2 cases of oropharyngeal carcinoma.Latissimus dorsi flap was prepared according to the defect area after tumor resection.The maximum incision area was 12.0 cm × 24.0 cm,and the donor area was closed directly.The survival of latissimus dorsi flaps was observed after surgery,and the recovery of the donor and recipient areas and tumor recurrence were observed during follow-up.Results All flaps survived and the donor and recipient areas healed primarily.After 6-24months of follow-up,both the appearance of the flap and the donor area recovered well;three patients had postoperative recurrence of tumor and were treated again.Conclusion Application of free latissimus dorsi flap can effectively repair the large soft tissue defect after resection of oral and maxillofacial tumors,which is worthy of clinical appliation.