尺动脉皮瓣修复口腔颌面部软组织缺损

Accurate repair of oral and maxillofacial soft tissue defects with ulnar artery flap

目的探讨尺动脉皮瓣在口腔颌面部软组织缺损修复中的临床应用特点。方法回顾分析2021年6月—2023年7月采用尺动脉皮瓣修复的12例口腔颌面部缺损患者临床资料。其中男11例,女1例;年龄28~76岁,平均54.8岁。病变位于舌侧缘3例,舌根2例,舌口底4例,颊部、上牙龈、下唇各1例。病理类型:鳞状细胞癌11例,腺样囊性癌1例;按国际抗癌联盟(UICC)TNM分期:T3N0M05例,T3N1M02例,T4aN0M01例,T4aN1M01例,T4aN2bM01例,T4aN2cM02例。彻底切除病变后缺损范围为6 cm×3 cm~8 cm×5 cm。术前采用彩色多普勒超声探测非优势侧前臂,测量供区皮下脂肪厚度,确认并标记尺动脉及回流静脉走行,测量管径、流速、穿支点等参数;术中依据相应数据设计、制取、吻合、就位皮瓣。吻合血管均采用一动两静,形成超回流。供区彻底止血后,根据局部缺损情况相应选择滑行皮瓣(2例)、拉拢缝合(4例)、生物膜(2例)或刃厚皮片(4例)修复。结果术后无血管危象发生,12例皮瓣均成活;10例供区创面Ⅰ期愈合,2例Ⅱ期愈合;受区创面均Ⅰ期愈合。12例患者均获随访,随访时间5~18个月,平均11.4个月。皮瓣颜色、质地均正常。根据中华医学会手外科学会上肢部分功能评定试用标准评价手及上肢功能为65~81分,平均71.3分,获优1例、良11例。口腔健康影响程度量表(OHIP-14)评分为9~18分,平均14.2分,口腔功能满意。随访期间1例肿瘤局部复发,再次行肿瘤扩大切除术,其余患者无复发转移。结论对于口腔颌面部功能复杂的中等软组织缺损,尺动脉皮瓣修复效果良好。

Objective To investigate the characteristics of the clinical application of ulnar artery flap in the repair of oral and maxillofacial soft tissue defects.Methods The clinical data of 12 patients with oral and maxillofacial defects repaired with ulnar artery flap between June 2021 and July 2023 was retrospectively analyzed.Among them,11 cases were male and 1 case was female;their ages ranged from 28 to 76 years,with a mean age of 54.8 years.The lesions were located in the lateral margin of the tongue in 3 cases,the root of the tongue in 2 cases,the base of the tongue in 4 cases,and the buccal region,upper gingiva,and lower lip in 1 case each.The pathological types were squamous cell carcinoma in 11 cases and adenoid cystic carcinoma in 1 case;according to the TNM staging of the International Union Against Cancer(UICC),there were 5 cases of T3N0M0,2 cases of T3N1M0,1 case of T4aN0M0,1 case of T4aN1M0,1 case of T4aN2bM0,and 2 cases of T4aN2cM0.After complete resection of the lesion,the defect ranged from 6 cm×3 cm to 8 cm×5 cm.Preoperatively,colour Doppler ultrasound was used to detect the non-dominant forearm,measure the thickness of the subcutaneous fat in the donor area,confirm and mark the ulnar artery and reflux vein,and measure the diameter of the vessels,flow velocity,and the perforator position;intraoperatively,the flap was designed,prepared,anastomosed,and positioned according to the corresponding data.The vessels were all anastommosed with one artery and two veins to form a super-reflux.After complete hemostasis,the defects were repaired with sliding flap(2 cases),direct suture(4 cases),biomembrane(2 cases),or razor thin skin graft(4 cases).Results No vascular crisis occurred after operation,and all the flaps survived in 12 cases.Wounds in the donor site healed by first intention in 10 cases and by second intention in 2 cases.Wounds in the recipient site healed by first intention in all cases.All 12 patients were followed up 5-18 months,with an average of 11.4 months.The colour and texture of the flap were normal.The function of hand and upper limb was evaluated according to the trial standard of upper limb function assessment of the Chinese Society of Hand Surgery of the Chinese Medical Association,and the score was 65-81(mean,71.3),and achieved excellent in 1 case and good in 11 cases.The score of Oral Health Impact Scale(OHIP)was 9-18,with an average of 14.2,and the oral function was satisfactory.During the follow-up,1 case had local recurrence and underwent extended resection again,while the other patients had no recurrence or metastasis.Conclusion For moderate soft tissue defects with complex oral and maxillofacial function,ulnar artery flap repair is effective.