上颌骨缺损类型与游离组织瓣修复选择的初步研究

目的 观察和评价应用不同游离组织瓣Ⅰ期修复上颌骨切除术后缺损的效果.方法 同顾性分析1997年10月至2010年6月中国医学科学院肿瘤医院头颈外科应用游离组织瓣Ⅰ期修复因肿瘤切除造成的上颌骨缺损共66例,其中43例为术后复发挽救性手术.46例患者曾行放射治疗.上颌骨Brown缺损类型分别为:Ⅰ型10例,Ⅱ型13例,Ⅲ型23例,Ⅳ型20例.游离组织瓣种类有:腓骨肌皮瓣26例.前臂桡侧皮瓣10例,背阔肌肌皮瓣7例,腹直肌肌皮瓣7例,股前外侧穿支皮瓣7例,腹壁下动脉穿支皮瓣5例,背阔肌-肋骨肌皮瓣2例,髂骨肌皮瓣2例.术后对29例患者进行外观和功能评估.结果 游离组织瓣修复成功率为93.9%(62/66).修复失败的4例中3例为腹直肌肌皮瓣,1例为腓骨肌皮瓣.术后对29例患者进行功能评估,62.1%(18/29)的患者恢复普通饮食,交流基本无障碍的比例为82.8%(24/29),对外观满意的比例为86.2%(25/29).结论 对于上颌骨Ⅰ型缺损建议主要采用游离前臂皮瓣修复,Ⅱ型和Ⅲ型主要以游离腓骨肌皮瓣,Ⅳ型采用穿支皮瓣修复.

Abstract：

Objective To evaluate the efficacy of the distinct free flaps in reconstruction of different types of maxillectomy defects. Methods A retrospective reviews was performed of in 66 consecutive cases of reconstructions with free flaps for maxillary tumor ablation defects from October 1997 to June 2010. There were 43 patients who had recurrences after previous operations and 46 patients had accepted radiation therapy before. According to the classification of Brown's maxilla defect; 10 cases were in class Ⅰ ,13 in class Ⅱ , 23 in class Ⅲ and 20 in class Ⅳ. The reconstructive free flaps included 26 fibula flaps, 10 radial forearm flaps, 7 latissimus dorsi flaps, 7 rectus abdominis flaps, 7 anteriolateral thigh perforator flaps, 5 deep inferior epigastric artery perforators, 2 latissimus dorsi/rib flaps and 2 iliac crest flaps. Postoperative features and functions were assessed in 29 patients. Results The overall free flap success rate was 93. 9% (62/66). Three rectus abdominis flaps and one fibula flap failed. There were 29 patients who received postoperative function assessment Sixty-two percent of the patients restored to taking regular diets, 24(82. 8% ) patients had normal language communication ability, and 25(86.2%) patients were satisfied with their feature. Conclusions Radial forearm flap was recommended to reconstruct the class 1 defect, fibula flap to class 2 or class 3 and preforatoe flap to class 4.

Microvascular free flap reconstructive options in patients with different types of maxillectomy defects

Objective To evaluate the efficacy of the distinct free flaps in reconstruction of different types of maxillectomy defects. Methods A retrospective reviews was performed of in 66 consecutive cases of reconstructions with free flaps for maxillary tumor ablation defects from October 1997 to June 2010. There were 43 patients who had recurrences after previous operations and 46 patients had accepted radiation therapy before. According to the classification of Brown's maxilla defect; 10 cases were in class Ⅰ ,13 in class Ⅱ , 23 in class Ⅲ and 20 in class Ⅳ. The reconstructive free flaps included 26 fibula flaps, 10 radial forearm flaps, 7 latissimus dorsi flaps, 7 rectus abdominis flaps, 7 anteriolateral thigh perforator flaps, 5 deep inferior epigastric artery perforators, 2 latissimus dorsi/rib flaps and 2 iliac crest flaps. Postoperative features and functions were assessed in 29 patients. Results The overall free flap success rate was 93. 9% (62/66). Three rectus abdominis flaps and one fibula flap failed. There were 29 patients who received postoperative function assessment Sixty-two percent of the patients restored to taking regular diets, 24(82. 8% ) patients had normal language communication ability, and 25(86.2%) patients were satisfied with their feature. Conclusions Radial forearm flap was recommended to reconstruct the class 1 defect, fibula flap to class 2 or class 3 and preforatoe flap to class 4.