颏下岛状皮瓣在头颈外科的应用

目的 结合应用颏下岛状皮瓣修复头颈肿瘤术后组织缺损的体会，对颏下岛状皮瓣的解剖、制作、适应证及优缺点等进行论述。方法 以面动脉、面静脉的分支支颏下动、静脉为蒂制成岛状皮瓣，采用逆行解剖法，先切取皮瓣，由前向后连同同侧颌下腺向近心端分离，解剖出面动脉，保留颏下动脉、静脉，切除颌下腺及淋巴结。结果 进行颏下岛状皮瓣修复的16例患者，成活15例，失败1例，成功率93．8％。结论 颏下岛状皮瓣适用多种头颈肿瘤术后的一期重建，它具有长而可靠的血管蒂，操作简单，供皮区缝合后切口隐蔽，对外观影响较小，无需血管吻合等优点。但对术前放疗供皮区包括在放疗野内之患者以及颏下、颌下有淋巴结转移的患者，该皮瓣不适用。

The Application of Submental Island Flap in Head and Neck Surgery

OBJECTIVE: This article discusses the anatomy, surgical procedure,indication, advantages and disadvantages of the submental island flap in reconstruction of the defects after head and neck tumor surgery, based on our clinical experience. METHODS: The submental island flap was transferred with the submental vessels(A/V) as pedicle. In harvesting the flap, the flap was raised commencing from the contralateral side, dissecting all tissues off the mylohyoid muscles. Submandibular triangle dissection was taken until the facial artery and the facial vein. Then the submandibular gland and submandibular nodes were removed and submental vessels were left. This produces a large skin paddle which can be tunnelled to its recipient site. RESULTS: From Aug. 1998 to Oct. 1999, 16 submental island flaps were performed in our department. 15 flaps survived well and 1 flap failed, with a success rate of 15/16 (93.8%). CONCLUSION: The submental island flap is appropriate for primary reconstruction of the defect after various head and neck tumor surgery. It has a long and reliable pedicle, rapid and simple to raise and free from vessel anastomosis. It leaves a well hidden donor site. However, it can't be applied to these cases whose donor site had been radiated before surgery and whose submental and submandibular triangles lymph nodes were positive.