逆行蒂颏下瓣修补头面部缺损

目的探讨用逆行蒂颏下岛状组织瓣修补头面部缺损。方法回顾分析南京军区福州总医院耳鼻咽喉头颈外科2004年1月至2006年12月间逆行蒂颏下组织瓣修补因肿瘤切除导致面部、上颌或咽部缺损10例，男6例，女4例；年龄24～76岁，中位年龄55岁。其中上睑皮肤黑色素瘤手术缺损1例，硬腭肌上皮瘤2例，上颌造釉细胞瘤1例，扁桃体癌4例，舌根癌2例。根据手术缺损大小切取颏下组织瓣，以面动静脉远心端为蒂，经面部皮下或经颌下转移至缺损区修补缺损。4例扁桃体癌和2例舌根癌同期行同侧经典性颈清扫术。结果术后皮瓣均有不同程度肿胀苍白或淤血，5d后皮瓣肿胀逐渐消退，色泽逐渐恢复正常。1例淤血严重，经针刺放血、药物治疗，一期愈合。另1例皮瓣与硬腭在中缝处裂开2cm，再次清创缝合后愈合，1例同侧口角轻度偏斜，药物治疗3个月后恢复。所有病例术后皮瓣均成活。结论逆行蒂颏下组织瓣由于蒂在上方，可以向上转移较远距离而修补面中部、眼裂周围缺损，并且可同时行颈淋巴清扫手术，也是修补有颈淋巴转移的口咽部恶性肿瘤手术缺损的一种良好选择。

Application of reversed pedicled submental island flap

OBJECTIVE: To explore the clinical applications of reversed pedicled submental island flap in the face and oropharynx. METHODS: The clinical data of ten cases of reconstruction of defect in the area of face or oropharynx following resection of tumors with reversed pedicled submental island flaps between January of 2004 to December of 2006 were retrospectively studied. The cases included six males and four females, aged from 24 to 76 (median 55 years). One of the cases suffered from upper lid melanoma, two hard palate myoepthelioma, one maxillary ameloblastoma, four tonsil cancer and two lingual carcinoma. The submental island flaps were dissected according to the area of the defection, the distal facial vessel was used as the pedicle of the flaps, and the flaps were transferred through under the skin of the face or the mandible to the area of the defection. Radical neck dissection was performed in the four tonsil cancers and two lingual carcinomas simultaneously. RESULTS: All the flaps showed pale, edema and/or congestion after the surgical treatment, but swelling and congestion disappeared gradually 5 days later. One of the cases suffered from severe congestion of the flap, but the flap survived by stabing with needle and draining. The flap of another case separated from the hard palate was sutured again, and healed. Lower lip palsy occurred in another case, and recovered 3 months later by conservative therapy. None of the flaps necrosed. CONCLUSIONS: Because of the upper pedicel, reversed pedicled submental island flap can be transferred to a long distance to reconstruct the defect in the upper face or around the orbit, and radical neck dissection can be performed simultaneously, it is a reasonable candidate in repairing the defect of the face and oropharynx.