晚期口腔癌术后颊部大范围洞穿性缺损的修复

目的:评价延长锁骨上岛状筋膜皮瓣联合延长垂直下斜方肌岛状肌皮瓣修复晚期口腔癌术后颊部大范围洞穿性缺损的可行性。方法:对我院2008年6月—2012年2月施行的17例延长锁骨上岛状筋膜皮瓣联合延长垂直下斜方肌岛状肌皮瓣修复晚期口腔癌切除后颊部黏膜和皮肤巨大洞穿性缺损病例进行回顾分析。结果:17例患者均伴晚期口腔癌切除后的颊部软硬组织巨大洞穿性缺损,修复口腔衬里的延长锁骨上岛状筋膜皮瓣大小为10 cm×8 cm～14 cm×10 cm,修复外部缺损的延长垂直下斜方肌岛状肌皮瓣大小为15 cm×8 cm～25 cm×10 cm。所有病例均无严重并发症,随访6～34个月,9例患者无瘤生存,2例带瘤生存,6例死于局部复发及远处转移。结论:应用延长锁骨上岛状筋膜皮瓣复合延长垂直下斜方肌岛状肌皮瓣修复晚期口腔癌术后颊部大范围洞穿性缺损是一种可靠的修复方法,对于再次手术,以及放疗后病例,在一定程度上优于游离皮瓣等其他修复方法。     

折叠延长下斜方肌岛状皮瓣修复面颊部巨大洞穿性缺损

目的:探讨应用折叠延长下斜方肌岛状皮瓣修复面颊部巨大洞穿性缺损的可行性。方法:16例(男10例,女6例,年龄17～75岁,平均年龄55.4岁)面颊部恶性肿瘤扩大切除后面颊部巨大洞穿性缺损患者,采用折叠延长下斜方肌岛状皮瓣修复。皮岛宽7～8 cm,长8～31 cm,折叠修复面颊部洞穿性缺损,恢复口腔内衬里及外侧颊部皮肤。结果:16例皮瓣全部成活。患者面颈部外观良好,口腔功能满意。结论:折叠延长下斜方肌岛状肌皮瓣可作为修复口腔恶性肿瘤根治术后所致面颊部巨大洞穿性缺损的首选皮瓣,其操作简便,安全可靠。     

延长下斜方肌皮瓣修复复发性口腔癌术后缺损

目的探讨复发性口腔癌手术后口腔颌面部软组织缺损修复的理想方法.方法对6例复发性口腔鳞状细胞癌患者（舌、口底和颊部各2例）手术治疗,缺损区同期用延长下斜方肌岛状肌皮瓣修复.结果全部皮瓣成活,供区创口一期愈合,无肩臂运动功能障碍.经追踪观察,最长存活30个月,最短13个月,平均生存期为22.6个月.结论延长下斜方肌岛状肌皮瓣制作较简单,设计和转移灵活且皮瓣足够大,可作为复发肿瘤手术后大范围软组织缺损的修复材料.     

面动脉岛状肌皮瓣修复舌癌术后组织缺损12例

目的:探讨下颌下区面动脉岛状肌皮瓣修复舌癌根治术后组织缺损的可靠性及效果。方法 :选择2009-01—2012-01,韶关市第一人民医院口腔颌面外科收治的舌癌患者12例,其中男性7例,女性5例,全部采用下颌下区面动脉岛状肌皮瓣同期修复舌癌根治性切除术后半舌缺损,术后观察组织瓣成活情况、外形和功能、患者的生存状态以及癌瘤复发等情况。结果:12例患者中,皮瓣完全成活11例,1例皮瓣部分坏死。术后随访6～36个月,患者舌部皮瓣形态、质地良好,语言及吞咽功能理想。1例患者出现颈部肿瘤复发。结论:下颌下区面动脉岛状肌皮瓣可作为半舌缺损修复较理想的皮瓣,该术式简单,易成功,适合同期修复舌癌根治术后半舌缺损。     

横向颈阔肌肌皮瓣和面动脉-颏下动脉岛状肌皮瓣修复颊黏膜癌术后缺损

目的：评价横向颈阔肌肌皮瓣和面动脉-颏下动脉岛状肌皮瓣修复颊黏膜癌术后缺损的可靠性。方法：27例颊黏膜鳞状细胞癌手术切除后组织缺损，用颈阔肌肌皮瓣修复15例，面动脉-颏下动脉岛状肌皮瓣修复12例。男19例，女8例；年龄38～74岁，平均56．4岁；T1NOM0期6例，T2N0M0期19例，T3N0M0期2例。皮瓣大小为4．0cm×8．0cm。5．0cm×11．0cm。结果：颈阔肌肌皮瓣存活13例，3例小部分坏死，成功率为86．7％（13／15），面动脉-颏下动脉岛状肌皮瓣成功率为91．7％（11／12）。全部病例经6—24个月复查，受区功能正常，供区外形良好。局部复发1例，颈部复发2例。结论：颈阔肌肌皮瓣和面动脉-颏下动脉岛状肌皮瓣均适于颊黏膜中、小型缺损修复。面动脉-颏下动脉岛状肌皮瓣可能比颈阔肌肌皮瓣更为可靠。     

斜方肌肌皮瓣联合肩胛骨肌皮瓣修复晚期头颈肿瘤术后下颌骨贯穿性缺损6例报道

目的：评估斜方肌肌皮瓣联合肩胛骨肌皮瓣重建下颌骨洞穿性缺损的效果。方法：对6例复发性晚期头颈恶性肿瘤患者进行挽救性手术,均通过基于颈横血管系统（TCVs）的斜方肌肌皮瓣和肩胛骨骨肌皮瓣修复肿瘤根治术后下颌骨洞穿性缺损。结果：所有患者均具有骨组织和广泛的软组织缺损,其中下颌骨缺损类型包括4例H型,1例LCL型和1例C型缺损,挽救性手术后存在洞穿性软组织缺损。所有肿瘤均可被整块切除,无严重并发症。其中2例出现轻微并发症：1例出现口内皮瓣轻微坏死,1例皮瓣供区的部分伤口裂开。所有患者不需要鼻饲饮食,面部和颈部外观均令人满意或可接受,未表现出上肢运动严重受限。随访10~18个月,5例患者无复发迹象。结论：基于颈横血管系统（TCVs）的斜方肌肌皮瓣和肩胛骨骨肌皮瓣可作为重建颅面部洞穿性缺损的有效方法,修复晚期头颈部肿瘤患者挽救性手术的术后缺损,可达到令人满意的功能和美学效果。     

应用下蒂型斜方肌皮瓣修复放射性骨坏死致口腔面颈部软组织缺损

目的:采用下蒂型斜方肌肌皮瓣修复放射性骨坏死致口腔面颈部软组织缺损,评价其临床效果。方法:在对斜方肌及其血供进行显微外科解剖学研究的基础上,利用颈横动脉浅降支为蒂,设计下蒂型斜方肌皮瓣,皮瓣转移修复因放射性骨坏死致口腔、颌面及上颈部软组织缺损9例,共11侧。术后随访1～6个月,观察皮瓣生长情况和患者张口度的变化。结果:临床应用该肌皮瓣修复口腔、颌面及颈部组织缺损9例,其中2例采用双侧肌皮瓣转移修复,除1块皮瓣远端部分表皮坏死外,其余皮瓣均完全成活,且术后患者张口度最大者增加2.5cm。结论:下蒂型斜方肌皮瓣修复口腔、颌面及上颈部组织缺损的效果良好,成功率高,方法可靠,操作简单,是一种治疗颌骨放射性骨坏死的理想方法。     

胸大肌岛状肌皮瓣改良切取术及其的临床运用

目的:探讨胸大肌岛状肌皮瓣的在口腔颌面部软组织缺损修复中,按缺损的个体化需要而设计皮瓣的形状的可行性.方法:应用胸大肌岛状肌皮瓣共修复口腔缺损17例.设计的方法,术前根据颌面部组织获得性缺损或肿瘤的范围与预计术后组织缺损的大小和外形,结合皮瓣血管的走行,设计皮岛的外形,血管包括在肌蒂内,肌蒂范围可据受区组织缺损的量来设计.随访时间为术后1～12个月,评价皮瓣在颌面部的外形.结果:15例皮瓣修复成功,2例皮瓣完全坏死,2例皮瓣外形臃肿、牵拉影响口腔功能.结论:胸大肌岛状肌皮瓣修复口腔缺损,进行适形设计是非常安全的,有其优点,值得推广应用.     

垂直斜方肌肌皮瓣修复枕部术后组织缺损3例报道

目的：介绍应用垂直斜方肌肌皮瓣同期修复枕部肿瘤切除术后组织缺损的临床经验。方法：2005年6月-2006年4月。采用垂直斜方肌肌皮瓣同期修复枕部恶性肿瘤切除术后组织缺损3例，其中基底细胞癌1例，鳞状细胞癌1例．皮肤汗腺癌1例。3例均在当地医院作肿瘤局部手术切除后复发，遗留术后植皮坏死、颈淋巴结转移。根据组织缺损部位和大小设计肌皮瓣，同期行颈清扫术后，将肌皮瓣转移至枕项部，修复缺损。结果：3例肌皮瓣全部成活，修复效果令人满意。结论：垂直斜方肌肌皮瓣修复枕部缺损比较实用，术中不需要变更体位，可与联合根治术同期完成，供区可直接拉拢缝合。     

应用面动脉-颏下动脉岛状肌皮瓣修复舌癌术后缺损

目的：探讨面动脉-颏下动脉岛状肌皮瓣同期修复舌癌术后缺损的效果。方法：2005年1月—2006年1月收治舌癌患者11例,其中男6例,女5例,全部采用面动脉-颏下动脉岛状皮瓣对舌癌根治性切除后半舌缺损进行同期整复,皮瓣最小8cm×3cm,最大12cm×4.5cm。结果：11例皮瓣全部存活,术后随访1a,未发现复发和转移。全部皮瓣形态、质地良好,面部外形满意。结论：面动脉-颏下动脉岛状皮瓣具有可靠血供,操作简便安全,适合同期修复T2期舌癌术后半舌缺损。     

Extended vertical lower trapezius island myocutaneous flap for reconstruction of cranio-maxillofacial defects

This study explored an effective method for repairing cranio-maxillofacial soft-tissue defects following radical craniofacial surgery in four patients with malignant tumours involving the skull base and frontal region. The large cranio-maxillofacial soft-tissue defects were reconstructed using an extended vertical lower trapezius island myocutaneous flap based on the transverse cervical artery. The flap was 8-12 cm long and 5-7 cm wide. No major flap failure occurred, and there was no shoulder dysfunction. The patients were followed for 3-12 months. One patient suffered a local recurrence, and another died of lung metastasis 12 months postoperatively. The extended vertical lower trapezius island myocutaneous flap is a simple, reliable and large flap. It is preferred for reconstructing cranio-maxillofacial soft-tissue defects when a pedicled flap is used following craniofacial surgery for cancer.     

Extended vertical lower trapezius island myocutaneous flap in reconstruction of oral and maxillofacial defects after salvage surgery for recurrent oral carcinoma.

PURPOSE: The purpose of this study was to explore an effective repair method for oral and maxillofacial soft-tissue defects after salvage surgery for patients with recurrent oral carcinoma. PATIENTS AND METHODS: Eight patients (6 females and 2 males, mean age, 56.9 years) with recurrent oral squamous cell carcinoma of the tongue (n = 4), oral cavity floor (n = 2), and buccal (n = 2) were treated with salvage surgery, and the oral and maxillofacial soft-tissue defects were reconstructed primarily by extended vertical lower trapezius island myocutaneous flap. RESULTS: No flap failure occurred. The donor sites were closed primarily. There were no disabilities with regard to shoulder motion. Followed up after the operation, the survival period of the patients was 6 to 30 months and the average survival period was 13.1 months. There was 1 recurrent case. All of the patients survived. CONCLUSION: The extended vertical lower trapezius island myocutaneous flap, which is a simple, reliable and large flap, can be preferred as a salvage procedure for oral and maxillofacial soft-tissue defects after salvage surgery for patients with recurrent oral squamous cell carcinoma.     

Reconstruction of the tongue using an extended vertical lower trapezius island myocutaneous flap after removal of advanced tongue cancer

In this study we explored an effective method to repair defects in the tongue that had been produced during removal of advanced tongue cancer. Eighteen patients with advanced squamous cell carcinoma of the tongue were treated, and extended vertical lower trapezius island myocutaneous flaps based on the transverse cervical artery were used to repair more than half the tongue. No flap failed completely and no shoulder was affected. The lingual contours were excellent. The functional results in terms of speech and swallowing were satisfactory. The patients were followed up for 6 to 24 months. Three of them were alive with disease and two have died of the local recurrence or metastasis at 18 and 20 months, respectively. The extended vertical lower trapezius island myocutaneous flap is a large, simple, and reliable flap, which is preferred for reconstruction of defects of the tongue after removal of advanced tongue cancer.     

Reconstruction of through-and-through oral cavity defects with folded extended vertical lower trapezius island myocutaneous flap

Reconstruction of through-and-through defects of the head and neck is a challenge. In this clinical study we assessed the feasibility of the folded, extended, vertical, lower trapezius island myocutaneous flap (TIMF) for the reconstruction of 16 large through-and-through defects of the oral cavity, which were reconstructed after resection of oral cancer. The skin paddle was 5–7 cm wide and 11–20 cm long. The folded flap provides both inner and outer linings for through-and-through defects, and all the flaps survived. The appearance of the head and neck was acceptable, and oral function was satisfactory. The folded extended vertical lower TIMF is a large, simple, and reliable flap that is preferred for the reconstruction of large through-and-through defects after resection of oral carcinoma.     

折叠延长下斜方肌岛状皮瓣修复全喉切除术后巨大咽皮瘘8例报道

目的:探讨应用折叠延长下斜方肌岛状皮瓣修复全喉切除术后巨大咽皮瘘的临床效果。方法:8例（男7例,女1例;年龄46~65岁,平均年龄57.6岁）全喉切除术后巨大咽皮瘘患者,咽皮瘘直径2.0 cm×1.8 cm~4.5 cm×3.0 cm,采用折叠延长下斜方肌岛状皮瓣修复。皮岛宽5~9 cm,长10~23 cm,折叠修复咽皮瘘,恢复咽腔内衬里及外侧皮肤。结果:8例皮瓣全部成活,患者无继发咽皮瘘与咽狭窄,吞咽功能满意。结论:折叠延长下斜方肌岛状肌皮瓣可作为修复全喉切除术后巨大咽皮瘘的首选皮瓣,其操作简便,安全可靠。     

延长垂直下斜方肌岛状肌皮瓣修复重建大型头颈部缺损

颈横动脉供血的延长垂直下斜方肌岛状肌皮瓣(extended vertical lower trapezius island myocutaneous flap,eVLTIMF)用于修复重建大型头颈部缺损安全可靠。该瓣制备较简单,成活率高。供区较隐蔽,可直接关闭缝合,并发症少,肩部运动受影响较小;还可制备成折叠瓣,合并其他带蒂瓣或合并肩胛骨骨肌皮瓣修复特大洞穿性缺损或下颌骨缺损。eVLTIMF在头颈部大面积缺损修复,尤其是在晚期复发性头颈部肿瘤挽救手术后巨大缺损修复重建中起着重要作用。本文对斜方肌的临床应用解剖、 eVLTIMF瓣制备及其在颅颌面、口腔颌面和颌颈区缺损修复中的应用作一阐述。