摘要
目的:探讨股前外侧穿支嵌合皮瓣的制备要点及修复头颈肿瘤根治术后缺损的优缺点。方法:2007年12月—2011年3月制备股前外侧穿支皮瓣,同时解剖保护血管蒂上的肌分支,设计一蒂多岛的穿支嵌合皮瓣修复66例头颈肿瘤根治术后缺损。舌、口底癌32例,舌根、咽侧癌30例,颊癌2例,颌骨中央性鳞癌1例,腮腺癌1例。切取股前外侧皮瓣面积7cm×4cm～16cm×7cm,肌瓣约3cm×4cm,观察并发症及受、供区功能恢复情况,总结穿支嵌合皮瓣制取技术及优点。结果:65例穿支嵌合皮瓣成活,成活率98.5%。1例术后5d出现危象,最终放弃,创口均Ⅰ期愈合。2例发现无合适穿支血管,改用股前内侧穿支皮瓣修复成功。术后随访0.5～3a,皮瓣6个月后萎缩停止,局部外形丰满,语言及吞咽功能恢复满意。供区均拉拢缝合,瘢痕隐蔽,下肢无功能障碍。结论:逆行和顺行解剖技术相结合是制备穿支嵌合皮瓣的理想手段,能够帮助外科医师克服穿支血管的解剖变异。股前外侧穿支嵌合皮瓣能提供不同类型的组织进行三维修复,减少术后并发症(感染、瘘、血肿等)的发生率,是头颈肿瘤术后复合组织缺损修复的理想选择之一。
PURPOSE：To discuss and report the operative techniques for harvesting perforator-based chimeric flap in anterolateral thigh region and the advantages for head and neck reconstruction after en bloc resection.METHODS： A retrospective review was performed of perforator-based chimeric anterolateral thigh（ALT）flap for head and neck reconstruction since December of 2007 to March of 2011.66 perforator-based chimeric flaps were harvested including a skin paddle and a muscular flap supplied by one mother pedicle-descending branch of lateral circumflex femoral artery（d-LCFA）.32 flaps were used for the mobile tongue and floor of mouth reconstruction,30 flaps for base of the tongue and parapharyngeal walls,two for the buccal skin,one for hemimandible and one for parotid.The muscular flap were used to eliminate the dead space of submandibular area.Flaps size ranged from 7cm×4cm to 16cm×7cm and muscular flap was 3cm×4cm approximately.The complications and functions of both donor and recipient sites were recorded and the operative techniques of perforator-based chimeric flap elevation were generalized.RESULTS： All 65 flaps survived completely and the total survival percentage was 98.5%.Only one flap failed and was removed 5 days postoperatively.No complications（fistula,infection,hematoma,seroma et al） were observed in recipient and donor sites.Two anteromedial thigh flaps（AMT） were used for reconstruction due to no sizable perforators in the ALT region.All cases were followed up for 0.5-3 years.The flaps didn＇t atrophy after six months and the contour was satisfactory.The functions of speech and swallow were recovered well.All the donor sites were closed primarily and the scar was not obvious.The leg＇s function recovered well.CONCLUSIONS： Using a combination of retrograde and antegrade dissection is a safe and versatile method for harvesting a perforator-based chimeric flap.A chimeric flap including multiple components can meet the requirements of three-dimensional reconstruction.Perforator-based chimeric anterolateral thigh flap is one of the best choices for complex head and neck reconstruction after en bloc resection.
出处
《上海口腔医学》
CAS
CSCD
北大核心
2012年第1期107-112,共6页
Shanghai Journal of Stomatology
关键词
外科皮瓣
穿支
头颈部
股前外侧皮瓣
嵌合皮瓣
癌
Surgical flaps
Perforator
Head and neck
Anterolateral thigh flap
Chimeric flap
Carcinoma
