改良桡侧前臂游离皮瓣修复术治疗面颈部皮肤癌切除后组织缺损的效果

Effect of Modified Radial Forearm Free Flap Repair for Tissue Defects after Facial and Cervical Skin Cancer Resection

目的:探讨改良桡侧前臂游离皮瓣修复术治疗面颈部皮肤癌切除后组织缺损的效果。方法:选取2020年1月-2021年3月在蚌埠医学院第一附属医院口腔颌面外科接受治疗的60例面颈部皮肤癌患者作为研究对象,按随机数表法将患者分为改良组与对照组,各30例。两组均接受肿瘤扩大切除和同侧颈部淋巴结清扫术治疗,改良组行改良桡侧前臂游离皮瓣修复术治疗,对照组行胸大肌皮瓣修复术治疗。观察两组皮瓣成活率、预后情况、围手术期相关指标、并发症发生情况和生存质量评分。结果:改良组有1例发生术后血管危象,经手术探查及时抢救成功。对照组有2例发生术后血管危象,其中1例经手术探查及时抢救成功,1例最终出现皮瓣部分液化坏死。两组皮瓣存活率、皮瓣面积、皮瓣制备时间、术后引流量、缺损修复时间及住院时间比较,差异无统计学意义(P>0.05)。改良组并发症发生率均低于对照组,差异有统计学意义(P<0.05)。随访1年后,改良组华盛顿大学生存质量问卷(UW-QOL)评分中外观、吞咽功能、咀嚼功能及肩部运动方面评分均高于对照组,差异有统计学意义(P<0.05)。结论:改良桡侧前臂游离皮瓣修复术在面颈部皮肤癌切除后组织缺损治疗中具有较高的成功率,能够降低术后并发症发生风险,提升生存质量。

Objective:To explore the effect of modified radial forearm free flap repair for tissue defects after facial and cervical skin cancer resection.Method:A total of 60 patients with facial and cervical skin cancer who were treated in Department of Oral and Maxillofacial Surgery of the First Affiliated Hospital of Bengbu Medical College from January 2020 to March 2021 were selected as the study subjects.They were randomly divided into the modified group and the control group according to the random number table method,with 30 cases in each group.Both groups received extended tumor resection and ipsilateral neck lymph node dissection.The modified group received modified radial forearm free flap repair,and the control group received pectoralis major flap repair.Observed the survival rate of flaps,prognosis,perioperative related indicators,incidence of complications,and quality of life scores of the two groups.Result:A total of 1 case in the modified group experienced postoperative vascular crisis,which was successfully managed through surgical exploration and timely rescue.A total of 2 cases in the control group experienced postoperative vascular crisis,of which 1 case was successfully rescued through surgical exploration in a timely manner,and 1 case ultimately developed partial liquefaction and necrosis of the skin flap.There were no statistically significant differences in the survival rate,flap area,flap preparation time,postoperative drainage volume,defect repair time,and hospital stay between the two groups(P>0.05).The incidence of complications in the modified group was lower than that in the control group,and the difference was statistically significant(P<0.05).After 1 year of follow-up,the scores of appearance,swallowing function,chewing function,and shoulder movement in the University of Washington quality of life questionnaire(UW-QOL)in the modified group were higher than those in the control group,the differences were statistically significant(P<0.05).Conclusion:The modified radial forearm free flap repair has a high success rate in treatment of tissue defects after facial and cervical skin cancer resection,which can reduce the risk of postoperative complications and improve quality of life.