股前外侧肌皮瓣修复颊癌术后缺损23例临床分析
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摘要
目的 :探讨股前外侧肌皮瓣修复颊癌术后软组织缺损的效果。方法 :2013年5月—2015年5月以股前外侧肌皮瓣修复颊癌术后缺损患者23例。设计并制备股前外侧肌皮瓣单岛或者多岛,修复颊癌术后组织缺损。术后观察口腔颌面部及供区形态和功能,总结皮瓣制取及修复经验。结果:23例股前外侧皮瓣全部成活,其中3例术后24 h内出现血管危象,经抢救后皮瓣成活,成活率100%。随访1~3 a,口腔颌面部及供区形态、功能恢复良好,1例出现颊部积液并感染,经冲洗引流处理后恢复良好;2例术后复发、死亡。结论:股前外侧肌皮瓣修复颊癌术后软组织缺损效果良好,值得临床推广应用。
PURPOSE: This study was aimed to observe the effects of anterolateral thigh flap for reconstruction of tissue defects after en bloc resection of buccal cancer. METHODS: Twenty-three patients with soft tissue defects after en bloc resection of buccal cancer underwent simultaneous reconstruction with anterolateral thigh flap from May, 2013 to May,2015 were observed. Anterolateral thigh flaps were designed and harvested in form of single or multiple islands to restore the defect in buccal region after surgery. The appearance and function of both the oral and maxillofacial region and the donor site were recorded and evaluated. RESULTS: All the 23 flaps survived. Only 3 of them experienced vascular crisis within 24 hours after surgery, and recovered gradually after salvage. The success rate was 100%. One to three years of follow-up showed satisfying morphology and function for both the receipt sites and the donor sites. Buccal abscess was observed in 1 patient and recovered after rinsing and drainage. Two patients died of recurrence. CONCLUSIONS: Good effects can be achieved using anterolateral thigh flap to reconstruct buccal defects after en bloc resection of cancer, which is suitable for application in clinical practice.
PURPOSE: This study was aimed to observe the effects of anterolateral thigh flap for reconstruction of tissue defects after en bloc resection of buccal cancer. METHODS: Twenty-three patients with soft tissue defects after en bloc resection of buccal cancer underwent simultaneous reconstruction with anterolateral thigh flap from May, 2013 to May,2015 were observed. Anterolateral thigh flaps were designed and harvested in form of single or multiple islands to restore the defect in buccal region after surgery. The appearance and function of both the oral and maxillofacial region and the donor site were recorded and evaluated. RESULTS: All the 23 flaps survived. Only 3 of them experienced vascular crisis within 24 hours after surgery, and recovered gradually after salvage. The success rate was 100%. One to three years of follow-up showed satisfying morphology and function for both the receipt sites and the donor sites. Buccal abscess was observed in 1 patient and recovered after rinsing and drainage. Two patients died of recurrence. CONCLUSIONS: Good effects can be achieved using anterolateral thigh flap to reconstruct buccal defects after en bloc resection of cancer, which is suitable for application in clinical practice.
引文
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[3]黎彦彬,张令达,后军,等.2种不同方法修复颊黏膜缺损的临床观察[J].安徽医科大学学报,2015,10(2):217-219.
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[27]李建美,胡小峰,陈建民.股前外侧皮瓣在四肢软组织缺损中的临床应用[J].临床骨科杂志,2015,18(2):241-243.
[28]黄欣,周剑虹,许振华.舌缺损股薄肌皮瓣修复1例[J].口腔医学研究,2015,31(4):415-415.
[29]张猛,贺西京.游离股前外侧穿支皮瓣修复胫骨外露的临床研究[J].黑龙江医学,2016,40(1):13-14.
[30]李建瑞,林加豪,廖海,等.股前外侧皮瓣串联髂骨皮瓣修复重建前足弓伴足踝部软组织缺损[J].浙江创伤外科,2016,21(2):303-305.
[31]陈杰,黄文孝,周晓,等.晚期喉癌下咽癌术后缺损的修复[J].中国耳鼻咽喉颅底外科杂志,2016,22(2):120-124.
[32]周玉奇,周国强,周红光.应用股前外侧皮瓣加外固定架治疗小腿骨折合并软组织缺损临床疗效观察[J].世界最新医学信息文摘,2016,16(57):80.
[33]王志刚,刘韬,郝朝辉,等.VSD联合股前外侧游离皮瓣修复踝部碱烧伤[J].包头医学院学报,2016,32(6):72-73.
[34]Lee YC,Chen WC,Chou TM,et al.Anatomical variability of the anterolateral thigh flap perforators:vascular anatomy and its clinical implications[J].Plast Reconstr Surg,2015,135(4):1097-1107.
[35]Wong CH,Wei FC,Fu B,et al.Alternative vascular pedicle of the anterolateral thigh flap:the oblique branch of the lateral circumflex femoral artery[J].Plast Reconstr Surg,2009,123(2):571-577.
[36]Yildirim S,Gideroglu K,Akoz T.Anterolateral thigh flap:ideal free flap choice for lower extremity soft-tissue reconstruction[J].J Reconstr Microsurg,2003,19(4):225-233.
[37]Wolff KD,Holzle F,Kolk A,et al.Suitability of the anterolateral thigh perforator flap and the soleus perforator flap for intraoral reconstruction:a retrospective study[J].J Reconstr Microsurg,2011,27(4):225-232.
[38]高建华,罗力生,陈林峰,等.股前外侧皮瓣主要皮血管的体表定位[J].临床应用解剖学杂志,1984,2(3):161-163.
[39]Yu P,Youssef A.Efficacy of the handheld Doppler in preoperative identification of the cutaneous perforators in the anterolateral thigh flap[J].Plast Reconstr Surg,2006,118(4):928-933,934-935.
[40]黄健,沈毅,陆林国,等.应用高频彩超进行股前外侧穿支血管的术前定位与选择[J].中国口腔颌面外科杂志,2015,13(1):42-47.
[41]周虹,谭谦.股前外侧皮瓣穿支血管探测技术的研究进展[J].东南大学学报(医学版),2011,30(5):788-792.
[42]Wei FC,Mardini S.Free-style free flaps[J].Plast Reconstr Surg,2004,114(4):910-916.
[43]Brunetti B,Tenna S,Aveta A,et al.Free-style local perforator flaps:versatility of the v-y design to reconstruct soft-tissue defects in the skin cancer population[J].Plast Reconstr Surg,2013,132(2):451-460.
[44]Chang CC,Wong CH,Wei FC.Free-style free flap[J].Injury,2008,39(Suppl 3):S57-S61.
[45]D'Arpa S,Cordova A,Pirrello R,et al.Free style facial artery perforator flap for one stage reconstruction of the nasal ala[J].J Plast Reconstr Aesthet Surg,2009,62(1):36-42.
[46]Feng KM,Hsieh CH,Jeng SF.Free-style puzzle flap:the concept of recycling a perforator flap[J].Plast Reconstr Surg,2013,131(2):258-263.
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[2]白沙草,张森林.锁骨上动脉岛状瓣的应用解剖[J].中国口腔颌面外科杂志,2012,10(3):245-248.
[3]黎彦彬,张令达,后军,等.2种不同方法修复颊黏膜缺损的临床观察[J].安徽医科大学学报,2015,10(2):217-219.
[4]尤强,杨朝晖,张大明,等.3种方法修复口腔及口咽癌术后缺损1年后生存质量分析[J].中国口腔颌面外科杂志,2015,13(5):435-440.
[5]黄伟城,吴泽键,陈伟生.外侧斜方肌瓣修复口腔癌、口咽癌切除术后缺损的疗效分析[J].实用癌症杂志,2015,31(7):988-989.
[6]王为,陈杰.颈阔肌肌皮瓣修复口腔肿瘤术后缺损的临床应用(附31例报告)[J].中国医师杂志,2003,5(2):221-222.
[7]周茜.颈阔肌肌皮瓣修复口腔癌切除后缺损的综合评价研究[D].长沙:中南大学,2013.
[8]曾威,卢文辉,张志利,等.颈阔肌皮瓣在颊癌术后缺损修复中的应用[J].口腔疾病防治,2016,24(6):345-348.
[9]林艺.颏下岛状肌皮瓣修复颊癌术后的护理[J].黑龙江医药科学,2016,39(3):106-109.
[10]翟沁凯,王绪凯,卢利,等.游离皮瓣移植修复口腔颌面部缺损的临床效果观察[J].口腔医学,2011,31(3):162-165.
[11]唐举玉,李康华,谢松林,等.游离皮瓣移植修复小儿四肢创伤性软组织缺损[J].中华显微外科杂志,2006,29(1):58-60.
[12]张彬,李德志,唐平章.穿支游离皮瓣修复头颈肿瘤术后缺损[J].中华整形外科杂志,2006,22(5):347-350.
[13]侯书健,程国良,方光荣,等.游离皮瓣移植修复手部及前臂皮肤缺损407例分析[J].中华手外科杂志,2006,22(5):259-262.
[14]Koshima I,Yamamoto H,Hosoda M,et al.Free combined composite flaps using the lateral circumflex femoral system for repair of massive defects of the head and neck regions:an introduction to the chimeric flap principle[J].Plast Reconstr Surg,1993,92(3):411-420.
[15]Tansatit T,Wanidchaphloi S,Sanguansit P.The anatomy of the lateral circumflex femoral artery in anterolateral thigh flap[J].J Med Assoc Thai,2008,91(9):1404-1409.
[16]冯运垒,叶淦湖,腾范文,等.旋股外侧血管蒂复(联)合组织瓣移植的解剖学基础[J].中国临床解剖学杂志,2004,22(5):533-535.
[17]江奕恒,徐达传,李学雷,等.股前外侧区皮瓣血管3D可视化研究与皮瓣设计[J].中华显微外科杂志,2007,30(6):433-436.
[18]郭峰,闵安杰,蒋灿华,等.应用游离股前外侧皮瓣修复口腔颌面部恶性肿瘤术后缺损[J].上海口腔医学,2011,20(1):62-65.
[19]苏文玲,赵德安,刘庆华.游离股前外侧穿支皮瓣重建头颈肿瘤术后缺损[J].中国中西医结合耳鼻咽喉科杂志,2012,20(6):440-442.
[20]任振虎,吴汉江,谭宏宇,等.1212块股前外侧肌皮瓣在口腔颌面缺损修复中的应用[J].华西口腔医学杂志,2015,33(3):281-285.
[21]任家晨,白建礼,付强,等.股前外侧皮瓣的临床应用[J].临床医药文献电子杂志,2015,2(32):6740-6741.
[22]任振虎,吴汉江,谭宏宇,等.35例股前外侧游离皮瓣血管危象临床分析[J].上海口腔医学,2016,25(1):112-116.
[23]邓铁红,王科,蔡永聪,等.股前外侧穿支皮瓣在头颈肿瘤外科应用中的研究进展[J].肿瘤预防与治疗,2016,29(2):97-101.
[24]戴捷,周晓,喻建军,等.头颈部巨大皮肤恶性肿瘤切除术后缺损修复[J].中国耳鼻咽喉颅底外科杂志,2016,22(2):125-128.
[25]董爱国.股前外侧皮瓣游离移植修复小腿软组织缺损的临床疗效[J].中国老年学杂志,2015,35(2):488-489.
[26]韩俊,刘仁甫.股前外侧游离皮瓣移植修复手腕部软组织缺损的临床观察[J].临床医药文献电子杂志,2014,1(9):1579-1581.
[27]李建美,胡小峰,陈建民.股前外侧皮瓣在四肢软组织缺损中的临床应用[J].临床骨科杂志,2015,18(2):241-243.
[28]黄欣,周剑虹,许振华.舌缺损股薄肌皮瓣修复1例[J].口腔医学研究,2015,31(4):415-415.
[29]张猛,贺西京.游离股前外侧穿支皮瓣修复胫骨外露的临床研究[J].黑龙江医学,2016,40(1):13-14.
[30]李建瑞,林加豪,廖海,等.股前外侧皮瓣串联髂骨皮瓣修复重建前足弓伴足踝部软组织缺损[J].浙江创伤外科,2016,21(2):303-305.
[31]陈杰,黄文孝,周晓,等.晚期喉癌下咽癌术后缺损的修复[J].中国耳鼻咽喉颅底外科杂志,2016,22(2):120-124.
[32]周玉奇,周国强,周红光.应用股前外侧皮瓣加外固定架治疗小腿骨折合并软组织缺损临床疗效观察[J].世界最新医学信息文摘,2016,16(57):80.
[33]王志刚,刘韬,郝朝辉,等.VSD联合股前外侧游离皮瓣修复踝部碱烧伤[J].包头医学院学报,2016,32(6):72-73.
[34]Lee YC,Chen WC,Chou TM,et al.Anatomical variability of the anterolateral thigh flap perforators:vascular anatomy and its clinical implications[J].Plast Reconstr Surg,2015,135(4):1097-1107.
[35]Wong CH,Wei FC,Fu B,et al.Alternative vascular pedicle of the anterolateral thigh flap:the oblique branch of the lateral circumflex femoral artery[J].Plast Reconstr Surg,2009,123(2):571-577.
[36]Yildirim S,Gideroglu K,Akoz T.Anterolateral thigh flap:ideal free flap choice for lower extremity soft-tissue reconstruction[J].J Reconstr Microsurg,2003,19(4):225-233.
[37]Wolff KD,Holzle F,Kolk A,et al.Suitability of the anterolateral thigh perforator flap and the soleus perforator flap for intraoral reconstruction:a retrospective study[J].J Reconstr Microsurg,2011,27(4):225-232.
[38]高建华,罗力生,陈林峰,等.股前外侧皮瓣主要皮血管的体表定位[J].临床应用解剖学杂志,1984,2(3):161-163.
[39]Yu P,Youssef A.Efficacy of the handheld Doppler in preoperative identification of the cutaneous perforators in the anterolateral thigh flap[J].Plast Reconstr Surg,2006,118(4):928-933,934-935.
[40]黄健,沈毅,陆林国,等.应用高频彩超进行股前外侧穿支血管的术前定位与选择[J].中国口腔颌面外科杂志,2015,13(1):42-47.
[41]周虹,谭谦.股前外侧皮瓣穿支血管探测技术的研究进展[J].东南大学学报(医学版),2011,30(5):788-792.
[42]Wei FC,Mardini S.Free-style free flaps[J].Plast Reconstr Surg,2004,114(4):910-916.
[43]Brunetti B,Tenna S,Aveta A,et al.Free-style local perforator flaps:versatility of the v-y design to reconstruct soft-tissue defects in the skin cancer population[J].Plast Reconstr Surg,2013,132(2):451-460.
[44]Chang CC,Wong CH,Wei FC.Free-style free flap[J].Injury,2008,39(Suppl 3):S57-S61.
[45]D'Arpa S,Cordova A,Pirrello R,et al.Free style facial artery perforator flap for one stage reconstruction of the nasal ala[J].J Plast Reconstr Aesthet Surg,2009,62(1):36-42.
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