带肋胸膜的肋骨-胸大肌复合瓣修复晚期舌癌根治术后缺损

目的探讨应用带肋胸膜的肋骨-胸大肌复合瓣联合修复晚期舌癌根治术后软硬组织大型缺损的临床效果和安全性。方法对6例累及同侧口底和下颌骨并越过中线的晚期舌癌患者实施舌颌颈联合根治术,开胸切取以胸肩峰动静脉为血管蒂的带肋胸膜的肋骨（第5肋）．胸大肌复合瓣即刻修复根治术导致的全舌、口底和下颌骨大型复合组织缺损,其中胸大肌肌皮瓣用以重建全舌和口底,肋骨瓣则用以修复患侧下颌骨。结果6例患者术后恢复良好。肋骨．胸大肌复合瓣全部成活,术后口腔、颈部和胸部创面均一期愈合。重建全舌、口底和面下部形态良好,上下颌咬合关系正常,下颌骨无偏斜,语言和吞咽功能基本恢复正常。结论带肋胸膜的肋骨．胸大肌复合瓣修复口腔颌面大型软硬组织缺损安全可靠,开胸切取肋胸膜不会导致患者术后胸廓运动和呼吸功能异常及其他胸肺部并发症,而且制备简便,带肋胸膜确保了肋骨-胸大肌复合瓣中肋骨的血运。     

口外入路中晚期舌癌切除及腹直肌皮瓣重建

目的 报道经口外入路中晚期舌癌切除、游离腹直肌皮瓣重建的方法及临床评价. 方法 常规颈淋巴清扫,完整保留下颌骨,将全舌及口底组织由颌下及颏下牵拉到口腔外切除.制备游离腹直肌皮瓣,皮瓣后分与会厌谷前方及舌骨上肌肉残端缝合后由口腔外转移到口腔内,周围与牙槽粘膜缝合固定,再造全舌及口底.受-供区血管显微吻合. 结果 临床应用6例,皮瓣全部成活,面形无改变.术后随访12～30个月,5例重建的舌及口底形态满意,呈隆起型或半隆起型,咀嚼、吞咽及语音功能恢复良好;1例舌及口底形态呈平坦型,语音功能恢复尚可,饮食及吞咽功能恢复较差.3例味觉恢复良好,3例味觉恢复较差.肿瘤无复发或转移. 结论 通过严格掌握适应证,经口外入路中晚期舌癌切除、腹直肌皮瓣重建是可靠和理想的方法.     

胸锁乳突肌肌皮瓣修复口底恶性肿瘤术后缺损的疗效分析

目的：探讨胸锁乳突肌肌皮瓣修复口底癌术后缺损的疗效。方法：回顾性分析5例口底癌术后缺损采用胸锁乳突肌肌皮瓣进行修复治疗,术后6个月、1年、2年随访。结果：5例中1例肌蒂皮瓣全部成活,3例远端部分发生坏死,肉芽组织生长修复;1例表皮脱落后上皮再生愈合。随访6个月～2年,口底形态及功能恢复良好,舌活动度良好,未见肿瘤复发或淋巴结转移。结论：胸锁乳突肌肌皮瓣血供恒定,容易成活,适用于口底缺损的修复。     

舌癌行胸大肌肌皮瓣转移修复术的护理

<正> 舌癌是最常见的口腔恶性肿瘤,一般采用原发灶切除加颈淋巴结清扫术,对波及口底及下颌骨的舌癌则施行一侧舌下颌骨切除及颈淋巴结联合清扫术。这种传统的手术会造成面部塌陷,影响功能及美容。舌切除1/2后,会严重影响进食及发音,导致患者的生活质量下降。我院首次采用胸大肌肌皮瓣转移修复术治疗舌癌1例,用肌皮瓣修复舌体及面颊部,既达到根治癌肿,又保持了患者面部的完整及舌功能正常,提高了患     

个体化设计的股前外侧复合肌皮瓣修复舌癌根治术后舌及口底缺损

目的 探讨应用个体化设计的游离股前外侧复合肌皮瓣,修复舌癌根治术后舌及口底缺损的效果.方法 2006年至2008年应用个体化设计的游离股前外侧复合肌皮瓣,修复31例舌癌根治术后舌及口底缺损,22例皮瓣的穿支血管类型为肌皮穿支,9例为肌间隙穿支;皮瓣大小为(4～8)cm×(5～10)cm,所携带股外侧肌大小为(2～5)cm×(3～6)cm,血管蒂的长度为(6.81±3.23)cm.结果 31例游离股前外侧复合肌皮瓣手术均获成功,舌外形及功能恢复良好,口底及下颌下区饱满;受区及供区伤口一期愈合,未发现口底瘘、下肢运动和感觉功能障碍等并发症,经1～3年的随访,28例无瘤生存,外观及功能满意,2例因术后出现对侧颈淋巴结转移再次手术;1例术后因远处转移死亡.结论 个体化设计的游离股前外侧复合肌皮瓣具有可重建良好的舌及口底形态,恢复舌功能,供区部位隐蔽和并发症少等优点,是修复舌癌根治术后舌及口底缺损的理想的首选皮瓣.     

喉黏膜瓣和胸大肌肌皮瓣修复晚期梨状窝癌术后缺损

目的探讨对不保留喉的晚期梨状窝癌,采用喉黏膜瓣和胸大肌肌皮瓣修复咽部及颈段食管缺损的方法及治疗效果. 方法 1995年～2001年对12例晚期梨状窝癌患者行半喉部分咽切除术,其中2例同时行颈段食管切除术,用喉黏膜瓣修复咽及颈段食管缺损;对4例累及双侧喉部者行全喉部分咽切除术,用胸大肌肌皮瓣修复咽部缺损. 结果术中无死亡.组织瓣均成活,仅喉黏膜瓣组1例术前行放疗者术后发生咽漏;全部患者愈合后经口进普食,吞咽功能恢复好,无咽及食管良性狭窄.1例于术后10个月死于全身广泛转移,另3例分别于术后1年死于局部肿瘤复发、颈部淋巴结肿瘤复发和肺部转移,其余12例已存活2年以上. 结论喉黏膜瓣修复晚期梨状窝癌术后咽部及颈段食管缺损,手术取材及操作简便,创伤小,并发症少;如梨状窝癌累及双侧喉部,需用胸大肌肌皮瓣进行修复.     

双侧同期颈淋巴清扫术的麻醉处理

伴有双侧颈淋巴结转移的口腔颌面部恶性肿瘤有时需采用双侧同期根治性颈淋巴结清扫术。由于其手术要结扎切断双侧颈内静脉、导致颅内静脉主要回流道路阻断,静脉回流受限使毛细血管压力过高引起脑水肿,继而引起颅内压(ICP)升高又加重脑水肿,麻醉处理的好坏对保证手术前后患者的安全起着很重要的作用。本文总结了我院为6例双侧颈清术患者的麻醉处理,现报告如下。临床资料 1.一般资料 6例全为男性,年龄37～65岁,其中舌癌4例,口底癌2例,舌癌采用舌颌颈联合根治术,口底癌采用口底颌颈联合根治术,修复采用胸大肌皮瓣4例,前臂皮瓣2例,6例术后均行气管切开术。     

改良胸大肌肌皮瓣在晚期头颈肿瘤手术中的应用

目的探讨一种保留胸大肌功能的改良胸大肌肌皮瓣的制作方法。方法根据胸大肌肌皮瓣的解剖学特点设计皮岛，将胸大肌肌皮瓣的血管蒂完全解剖出来而不携带肌肉，使肌皮瓣成为名副其实的岛状瓣，从而完整保留了胸大肌的锁骨部分以及胸大肌外侧大部分肌纤维。结果2002至2005年采用该方法制做改良胸大肌肌皮瓣29例，其中20例修复口内缺损，4例修复颈部缺损。3例修复腮腺区缺损，2例修复下咽部缺损。术后皮瓣全部成活，随访6个月至2年，所有患者术后进食、吞咽功能良好，语言功能大多恢复良好。结论改良胸大肌肌皮瓣应用于头颈外科克服了传统的胸大肌肌皮瓣的缺点，提高了肌皮瓣血供的可靠性，最大程度地保留了胸大肌的功能和胸部的外形。     

股薄肌皮瓣在修复舌癌术后缺损中的应用

目的:评价股薄肌皮瓣在舌癌术后缺损修复重建中的临床应用价值。方法:对7例舌癌患者在原发灶切除后利用股薄肌皮瓣行动力性舌再造,术后随访评价舌功能恢复情况。结果:7例股薄肌皮瓣均获得成功,再造舌外形丰满,运动良好,术后6个月均检测出不同程度的肌电信号,患者的言语、咀嚼、吞咽功能恢复满意。结论:股薄肌皮瓣位置表浅,供区隐蔽,血供稳定,容易塑形,可实现动力性舌再造,是修复舌癌术后缺损的一种较好选择。     

舌缺损的修复与再造

自1955年以来,治疗舌癌124例,其中54例进行了舌再造术,采用前臂皮瓣17例,额瓣15例、胸大肌皮瓣14例,胸锁乳突肌瓣1例,舌瓣6例,颊粘膜瓣1例。2例失败,52例成功。术后恢复了部分功能。作者认为,采用额瓣、前臂皮瓣、胸大肌皮瓣再造舌效果较好。     

Complications of the pectoralis major osteomyocutaneous flap used for head and neck reconstruction

The analysis of the complications of the pectoralis major osteomyocutaneous flaps used for head and neck reconstruction and how to prevent them is the subject of this report. Ten patients with squamous cell carcinoma of the floor of the mouth who had undergone segmental glossectomy and mandibulectomy, radical uni- or bilateral cervical lymphadenectomy, and immediate reconstruction with the pectoralis major osteomyocutaneous flaps were evaluated. Neither partial nor total necrosis of the myocutaneous segment occurred in any patient but rib necrosis developed in five. An oral fistula occurred in four patients exposing the junction of the rib with the mandible. There were three cases of flap necrosis of the neck dissection. Two patients developed pneumothorax. The overall complication rate was 66.7%. Although this surgery requires major intraoral excision, the tumor is exophytic with previous infection and the patients' general condition debilitated, the incidence of complications is high. Despite the high morbidity, the pectoralis major myocutaneous flap remains a useful adjunct for head and neck reconstruction. The flap is versatile and for many patients repair with a free flap is impossible because of contraindications such as previous irradiation, problems with the vascular anastomoses, advanced age and poor general condition. It also aids in the surgical training of new specialists.     

游离股前外侧肌皮瓣在舌癌术后缺损修复与舌再造中的应用

目的 探讨游离股前外侧肌皮瓣在舌癌术后缺损修复与舌再造中的应用.方法 2006年6月至2009年4月应用游离股前外侧肌皮瓣,对14例舌癌患者舌颌颈联合根治术后同期行舌口底缺损修复与舌再造,其中舌缘癌9例,舌腹癌3例,口底癌累及舌2例.肌皮瓣面积最大7 cm×9 cm,最小5 cm×7 cm.结果 14例肌皮瓣全部存活,供、受区伤口均一期愈合,无下肢运动感觉功能障碍.术后2周肌皮瓣略显臃肿,1个月后臃肿消退.随访12～26个月,再造舌形态良好,吞咽语言功能满意,肿瘤局部无复发,其中1例(T4N1M0)术后14个月死于远处转移.结论 股前外侧肌皮瓣组织量丰富,携带肌瓣可充填舌口底肌肉切除后缺损,再造舌外形及功能良好,供区隐蔽且对功能影响小,是舌癌术后舌、口底缺损修复与舌再造的理想选择.

Abstract：

Objective To investigate the application of free anterolateral thigh myocutaneous flap in the reconstruction of tongue and mouth floor defect after radical resection of tongue carcinoma. Methods From June 2006 to April 2009, 14 cases with tongue carcinoma underwent radical resection, leaving tongue and mouth floor defects which were reconstructed by anterolateral thigh myocutaneous flaps at the same stage. These 14 cases included tongue carcinoma at lingual margin( n = 9 ), at ventral tongue( n = 3 ) and at mouth floor( n = 2). The flap size ranged from 7 cm × 9 cm to 5 cm× 7 cm. Results All the 14 flaps survived completely with primary healing. There was no functional morbidity in the lower extremities. The patients were followed up for 12-26 months with satisfied esthetic and functional results in reconstructed tongue. Only one case (T4N1M0 )died of metastasis carcinoma 14 months after operation. No local recurrence happened. Conclusions The anterolateral thigh myocutaneous flap has abundant tissue volume to reconstruct the tongue and mouth floor defect, while leaving less morbidity at donor site. Both satisfied esthetic and functional results can be achieved.     

胸大肌肌皮瓣与钛板联合修复口腔癌根治术后的下颌骨缺损

目的探讨胸大肌肌皮瓣与钛板联合即刻修复口腔癌根治术后的下颌骨缺损的效果。方法2001年11月~2003年2月,对32例口腔癌根治术后下颌骨缺损患者,其中11例下颌牙龈癌行龈颌颈联合根治术,13例舌癌行舌颌颈联合根治术,4例口底癌行口底颌颈联合根治术,4例颊粘膜癌行颊颌颈联合根治术。术后遗留下颌骨缺损长度4~12 cm,邻近软组织缺损范围5.5 cm×7.6 cm~8.2 cm×10.5 cm,采用大小为6 cm×7 cm~9 cm×10 cm带蒂胸大肌肌皮瓣与钛板即刻修复。通过回顾性研究,分析其修复效果。结果术后肌皮瓣29例全部成活,3例有小部分皮岛坏死。均获随访2~19个月,27例面部外形基本满意,5例呈轻度不对称畸形;余留的上下颌牙咬牙合关系、咀嚼功能恢复良好;张口度2.7~3.4 cm;未出现与手术相关的颞颌关节疾病。结论胸大肌肌皮瓣与钛板联合应用是修复口腔癌根治术后伴较多软组织缺损和下颌骨节段性缺损较理想的方法。     

The pectoralis major muscle in head and neck reconstruction

From June 1980 to June 1985 51 pectoralis major muscle flaps have been used for one-stage reconstruction of extensive defects in the head and neck following cancer surgery. The pectoralis major muscle was used as a myocutaneous flap on 28 occasions, as a muscle covered with split thickness skin on 17 occasions, and as a muscle-only flap six times. The muscle, in its various forms, was used for reconstruction of the pharyngooesophageal segment, the tongue, floor of the mouth and oropharynx, to replace the skin of the face and neck, and to provide a well vascularized recipient bed for a split-rib graft, used to replace a defect of the anterior arch of the mandible. Many of the problems associated with the use of a pectoralis major myocutaneous flap can be avoided by the judicious use of a muscle flap on its own or covered by a split thickness skin graft.     

Salvage for pectoralis major myocutaneous flap failure in head and neck reconstruction by microvascular flap

Abstract

The pectoralis major myocutaneous pedicled flap (PMMPF) – the “workhorse” for head and neck reconstruction – is associated with a high incidence of complications in certain cases. This study presents free tissue transfer as an alternative salvage technique after PMMPF failure in head and neck reconstruction. It includes seven consecutive patients who underwent free tissue salvage after PMMPF failure in head and neck reconstruction from January 2008 to September 2010 at Kaohsiung Medical University Hospital, Taiwan. Four vertical rectus abdominis myocutaneous (VRAM) flaps were applied for tongue and mouth floor defects, while three anterolateral thigh (ALT) flaps were used for mouth floor, buccal, and cheek defects. All flaps survived uneventfully, and normal oral feeding was achieved without major complications. Free tissue transfer has several advantages and can be successfully employed in head and neck reconstruction, and it is also a reliable salvage procedure after PMMPF failure in such cases.     

舌癌连续整块切除血管化（肌）皮瓣修复重建术后的功能评价

目的评价舌癌连续整块切除同期行血管化（肌）皮瓣修复舌缺损后的语音、咀嚼功能。方法行手术治疗后6～18个月的舌癌患者共47例,其中行前臂皮瓣修复20例（前臂组,半舌以内14例,半舌以上16例）,股前外侧肌皮瓣修复27例（股前外侧组,半舌以内15例,半舌以上10例,全舌2例）。采用两因素两水平的析因设计与方差分析比较其语音和咀嚼效率;采用W ilcoxon秩和检验分析比较两个皮瓣组术后的舌颌沟深度改变值。结果与前臂皮瓣组比较,股前外侧组的舌颌沟深度改变值较小（P=0.000）,咀嚼效率较优（P=0.035）,但语音清晰度较低（P=0.006）。结论股前外侧皮瓣修复更有利于舌癌患者术后的咀嚼和进食,但前臂皮瓣短期内更有利于语音的恢复。     

Reconstruction of chin and lower lip using bilateral segmental pectoralis major myocutaneous flap with functional support

Summary A 21-year-old man sustained an extensive high voltage electrical injury to his lower face, lower lip, chin, mandibular symphysis and floor of mouth. He lost all soft tissue as well as the outer cortex of the mandibular symphysis and lower teeth at the entry site. This soft tissue and skin loss was replaced by a left segmental pectoralis major myocutaneous flap [3] for lining of floor of the mouth and a right segmental pectoralis major myocutaneous flap augmentation of the chin and lower lip. The function of muscles and modiolus and orbicularis oris was reasonably regained by using bilateral temporalis muscle functional support [7]. The soft tissue on the left lower face was replaced by expanding the skin and soft tissue on the left submandibular area.     

多种区域组织瓣在口腔颌面部缺损修复中的应用分析

目的:寻找口腔颌面部缺损的理想修复方法。方法:对97例口腔颌面部缺损,根据缺损部位、性质、范围,分别采用鼻唇沟皮瓣(6例),邻位滑行皮瓣(13例),Abbe瓣(4例),胸大肌肌皮瓣(17例),颈阔肌肌皮瓣(14例),下斜方肌肌皮瓣(4例),前臂皮瓣(13例),额瓣(6例),颞肌筋膜瓣修复(6例),舌瓣(11例),腓骨肌皮瓣(3例),观察修复效果。结果:97例区域组织瓣中,胸大肌肌皮瓣坏死1例,下斜方肌肌皮瓣尖端坏死1例,另1例胸大肌皮瓣术后放疗后坏死(术后4月),其余皮瓣存活,外形基本满意。所有患者均能进食,97%能正常饮食(食饭),其余可流质饮食。舌、腭、咽、口底肿物T3以上,术后语音轻度影响。结论:采用以上多种区域组织瓣修复口腔颌面部缺损,建议应尽可能采用邻近带蒂皮瓣;对于较大缺损修复主要是修复组织缺损,采用不同组织修复缺损,对进食、语音影响似区别不大,日后尚需作深入研究。