前臂皮瓣修复舌缺损感觉功能恢复的研究

目的:观察非感觉性游离桡侧前臂皮瓣修复舌缺损术后感觉功能的恢复情况。方法:追踪65例舌癌扩大切除同期行游离前臂皮瓣修复术患者,术后6～12个月复查,检测皮瓣的触觉、两点辨别觉、痛觉(钝锐觉)、方向觉和冷热觉的恢复情况。结果:29例皮瓣(44.6%)至少3/4面积有感觉恢复,32例皮瓣(50%)有部分感觉恢复,4例皮瓣(6.3%)无感觉恢复。结论:非感觉性游离前臂皮瓣修复舌缺损后可自行恢复感觉功能。放疗可能减缓甚至阻碍皮瓣感觉功能的恢复。     

口腔癌根治术后经游离皮瓣修复口腔缺损的感觉恢复效果探讨

目的 :考察游离皮瓣修复口腔癌术后口腔缺损的感觉恢复情况。方法 :回顾我院13例经游离皮瓣修复口腔缺损的口腔癌患者,按照其皮瓣位置分为A组(游离前臂皮瓣)及B组(游离腓骨肌皮瓣),对其术后6个月和12个月时修复区的感觉恢复情况进行评价。结果:6个月时,12例患者的感觉功能开始恢复,且以触觉和痛觉最先恢复。所有患者12个月时的感觉恢复程度均优于6个月时,表明皮瓣修复区的感觉恢复至少需6个月以上的时间。结论:游离前臂皮瓣、游离腓骨肌皮瓣对患者感觉功能的恢复作用相仿,均能够有效改善患者生存质量。     

前臂皮瓣与胸大肌皮瓣在口腔癌手术缺损修复中的应用

目的:观察前臂皮瓣和胸大肌皮瓣修复口腔癌手术缺损的治疗效果。方法:30例口腔癌患者在常规联合根治术后,随机分为A、B组,每组15例。A组采用前臂桡侧皮瓣游离移植同期修复口腔癌术后口腔颌面部缺损,B组采用胸大肌皮瓣同期修复口腔癌术后口腔颌面部组织缺损;对比两组的修复效果。结果:A组13例(86.67%)前臂皮瓣顺利成活,B组皮瓣成活率100%。A组中有6例患者虎口感觉消失、4例患者供区颜色极深或极浅;B组中有4例女性患者术后两侧乳房不对称。结论:前臂皮瓣和胸大肌皮瓣修复口腔癌手术缺损均具有较高的成功率,两种皮瓣均适用于口腔癌手术缺损修复。     

游离前臂皮瓣移植修复口腔颌面部软组织缺损的临床研究

目的 探讨应用显微外科技术进行游离前臂皮瓣移植修复口腔颌面软组织缺损的方法.方法 应用游离前臂皮瓣移植对11例口腔癌切除后软组织缺损进行修复.结果 术后观察1～12个月,皮瓣均存活,口腔功能恢复良好,外形满意.结论 前臂皮瓣移植是修复口腔癌术后颌面软组织缺损较为理想的方法.     

感觉性游离皮瓣修复口腔颌面部缺损的临床评价及研究进展

游离组织瓣移植是目前修复口腔颌面部缺损的常用方法，由于游离皮瓣位置灵活、血供可靠，不仅可以保证口腔恶性肿瘤扩大切除的彻底性，而且有助于术后功能的恢复。表面感觉与口腔功能密不可分，如咀嚼、吞咽、语言、唾液分泌、机体防御等都与口腔感觉密切相关。口腔颌面部缺损修复术后口腔感觉的恢复直接影响口腔功能的改善和生活质量的．提高，利用感觉性游离皮瓣修复口腔颌面部缺损的目的就是最大可能地恢复口腔颌面部的感觉功能。     

游离股前外侧皮瓣在口腔肿瘤术后组织缺损修复中的应用

目的 :探讨游离股前外侧皮瓣在口腔癌术后组织缺损修复中的应用效果。方法 :对5例(男性4例,女性1例,年龄60⁷2岁,平均年龄68.2岁)行股前外侧组织瓣移植,进行口腔颌面部软组织缺损修复的病例,进行分析总结。根据不同组织缺损的具体情况,应用不同组织瓣类型对缺损进行修复,并对术后效果和供区恢复情况进行评价。结果:5例游离皮瓣面积6 cm×10 cm72岁,平均年龄68.2岁)行股前外侧组织瓣移植,进行口腔颌面部软组织缺损修复的病例,进行分析总结。根据不同组织缺损的具体情况,应用不同组织瓣类型对缺损进行修复,并对术后效果和供区恢复情况进行评价。结果:5例游离皮瓣面积6 cm×10 cm⁸ cm×10 cm,移植皮瓣全部成活,术后近期及远期随访效果满意,供区无功能受限。结论:股前外侧组织瓣组织量丰富,可塑性良好,是修复颌面部软组织较大缺损的理想游离皮瓣。     

皮瓣及肌皮瓣移植感觉功能恢复过程的临床研究

非神经化皮瓣及肌皮瓣２９例，神经化皮瓣４例。非神经化瓣的感觉功能从术后３月起逐渐恢复，依次是痛觉、触压觉、温度觉和二点分辨觉。恢复从边缘向中央逐渐进行，术后２－３年，约６５．５％的组织瓣感觉功能取得较好恢复，此时痛觉、触压觉、温度觉和二点分辨觉的恢复率分别为６４．７％、６４．７％、５３．０％和２３．５％，其中，皮瓣感觉恢复较肌皮瓣为好。神经化皮瓣感觉再生恢复明显优于非神经化皮瓣。组织瓣的感染来源于     

颏下岛状皮瓣修复口腔癌术后组织缺损15例

目的:总结应用颏下岛状皮瓣修复口腔癌术后组织缺损的临床经验。方法:对1999～2004年采用颏下岛状皮瓣同期修复口腔癌术后组织缺损15例资料进行分析。结果:15例患者中,14例皮瓣全部成活,1例皮瓣部分坏死,经短期换药后愈合,术后随防3月～4年,外形和功能均满意。结论:颏下皮瓣具有长而可靠的血管蒂,操作简单,供区隐蔽,对外观影响小,是一种修复口腔癌术后中小型组织缺损的较好方法。     

前臂游离皮瓣修复口腔颌面部缺损的疗效分析

目的:总结用前臂区游离皮瓣修复口腔颌面部软组织缺损的临床应用经验。方法:对131例前臂区游离皮瓣修复口腔颌面部软组织缺损进行回顾性临床分析,其中37例患者进行了0.5～18年的随访观察。结果:本组131例成功率99.24%。远期随访观察供、受区恢复良好,部分患者皮瓣感觉有所恢复。结论:前臂区游离皮瓣是一种多功能的优良皮瓣,术中血管套接法优于缝合法,应尽量多吻合静脉,该皮瓣适合修复口腔颌面部各个区域的软组织缺损,其远期疗效较好。     

游离皮瓣修复舌癌术后缺损联合语音训练的语音功能评价

目的探讨舌癌术后缺损经游离皮瓣同期修复并结合语音训练后的语音功能恢复情况。方法舌癌患者15例,其中男8例,女7例,平均年龄54岁,T2期13例,T3期2例。均行舌癌扩大切除及患侧颈淋巴清扫术,根据舌体缺损大小制备游离前臂皮瓣或股前外侧皮瓣,完成舌体缺损重建,术后1个月行语音训练,术后6个月后行语音清晰度检查,分析患者术后语音功能恢复情况。结果15例患者皮瓣均完全成活,均获得创口一期愈合。重建后的舌均具有良好的活动度,15例患者的语音清晰度为90％—100％,平均语音清晰度为94.5％。结论游离皮瓣同期修复舌癌术后缺损结合术后语音训练,能够较好地恢复患者的语音功能。     

Sensory recovery of noninnervated free flap in oral and oropharyngeal reconstruction

The sensory recovery of noninnervated free flaps used in oral and oropharyngeal reconstruction is analysed retrospectively to evaluate the degree of sensory recovery in different free flaps; and to assess the influence of various clinical and surgical factors on the recovery. A total of 40 patients who underwent oral and oropharyngeal reconstruction with noninnervated radial forearm (24), jejunal (10) or gastro-omental (6) free flaps were studied for at least 12 months postoperatively. The modalities examined were light touch, sharp prick, hot and cold temperature and static two-point discrimination. All the modalities showed statistically significant recovery in all flaps (p<0.05). The degree of sensory recovery for each modality is highest in the radial forearm followed by gastro-omental and lastly jejunal flaps. The differences between radial forearm and gastro-omental/jejunal flaps are statistically significant (p<0.05) except for light touch. The differences between the later two groups of flaps did not show statistical significance (p>0.05). Sensory recovery for all modalities in all flaps was not dependent on sex, age, smoking, flap size, postoperative radiotherapy or follow-up period (p>0.05).     

Comparative study on sensory recovery after oral cavity reconstruction by free flaps: preliminary results.

Anatomical restoration was once the only goal of reconstructive surgery, but now it represents only one step in the complete functional recovery process to allow resumption of physiological activity. Soft tissue and nerves play important roles in functional recovery, but the potential of these structures is not yet well known. Rehabilitation after oral cavity reconstruction by free flaps needs an interdisciplinary diagnostic and therapeutic approach, in which neurosensory recovery of transferred tissue is an important aspect. Previous studies have used clinical assessment to evaluate sensory recovery after oral reconstruction with free flaps, but these results have been subjective and not quantifiable. The aim of the present study is to evaluate the sensory recovery using objective and standardized electrophysiological data by recording the masseter inhibitory reflexes (MIR) following mental and lingual electrical stimulation. A group of 14 patients who underwent oral cavity reconstruction by transplantation of either forearm (9) or jejunal (5) noninnervated free flaps were investigated. We found that sensory recovery of fasciocutaneous radial forearm free flaps was better than that of jejunal free flaps. This could represent the starting point for further studies about sensory recovery of reconstructed anatomical structures based on standardized and objective electrophysiological data.     

Spontaneous sensory recovery in non-innervated radial forearm flaps used for head and neck reconstruction

Although several studies have reported the use of reinnervated microvascular free flaps for oro-pharyngeal reconstruction, it has been known for some time that non-innervated flaps demonstrate spontaneous sensory recovery. This study sought to evaluate the degree of such spontaneous recovery in 50 radial forearm flaps used for mucosal reconstruction of head and neck ablative defects. The recovery of sensation to pinprick, light touch and temperature was tested a mean of 38 months (range 15-71) after surgical insetting. Two-point discrimination was also sought. Although 18 flaps (36%) remained anaesthetic, partial recovery in one or more modalities was present in 28 patients (56%). A recovery in all modalities of sensation in at least two-thirds of the flap area was recorded in 4 patients (8%). The mean 2-point static discrimination for fascio-cutaneous flaps was 18.9mm.     

游离组织辦在口腔颌面-头颈肿瘤缺损修复中的应用:2549例临床分析

目的:探讨不同游离组织瓣在口腔颌面-头颈肿瘤缺损与修复中的应用价值。方法:回顾分析1979年1月～2006年12月间,我院口腔颌面外科所行血管化游离组织瓣移植患者2549例,共制备皮瓣2684块:软组织瓣包括前臂皮瓣、背阔肌皮瓣、胸大肌皮瓣、股前外侧皮瓣、肩胛皮瓣等;骨组织瓣包括腓骨肌皮瓣、髂骨肌皮瓣、肩胛骨肌皮瓣等。分别用于修复舌、腭、颊、口底、颌骨及面颈部大面积复合缺损。统计各年代游离组织瓣移植的成功率,分析失败原因。结果:游离组织瓣移植成功率从80年代初期(92%)至今(98.5%),呈逐年升高趋势,2684块皮瓣总成功率达96.80%。前臂皮瓣是最常用的游离组织瓣(64.12%),胸大肌皮瓣和背阔肌皮瓣在修复大面积复合缺损常被采用,各种骨肌(皮)瓣应用于颌骨缺损修复成为近年的热点。大范围复合组织缺损的救治性手术常需要多个游离组织瓣联合修复重建。结论:血管化游离组织瓣移植是口腔颌面-头颈肿瘤手术根治的保障,更是术后缺损修复的主要手段。前臂皮瓣是修复舌、颊、腭等软组织缺损的首选瓣,胸大肌与背阔肌(皮)瓣适合修复体积较大的缺损,腓骨、髂骨肌瓣是上、下颌骨缺损最常用的修复手段。其他不常用的组织瓣,应根据不同适应证进行选择。采用不同组织瓣修复口腔颌面部缺损,对患者术后外形及功能具有重要意义。     

Functional and aesthetic reconstruction of full-thickness cheek, oral commissure and vermilion

PURPOSE: This paper presents surgical techniques for reconstruction of the cheek, oral commissure and vermillion in the repair of full-thickness cheek defects after resection of buccal-mucosal squamous cell carcinoma. PATIENTS AND METHODS: Four reconstructions in one-stage surgery with either a free radial forearm flap or a rectus abdominis musculocutaneous flap for cheek and oral commissure were carried out. There were combined with a new approach for vermillion advancement flaps. Most challenging was the need not only for morphological reconstruction of the orifice, but also for physiological reestablishment of sphincteric and sensory functions in the vermillion. RESULTS: Morphological and physiological reconstruction of the lip with sphincteric and sensory functions was attained. CONCLUSION: This valuable reconstruction technique was demonstrated in large, full thickness defects involving the cheek, oral commissure and vermilion.     

Long-term results of free radial forearm flap used for oral reconstruction: functional and histological evaluation.

PURPOSE: The aim of this study was to evaluate the radial forearm flap with regard to recovery of sensory function, general performance status, cutaneous blood flow and histological observations. PATIENTS AND METHODS: Thirty patients (23 male and 7 female) with oral carcinoma underwent immediate reconstruction with radial forearm flap after ablative surgery and returned for evaluation. Interviews were conducted to assess the degree of articulation and mastication. RESULTS: Sensory function tests suggested the restoration of cutaneous sensibility of the forearm flap. Histological findings indicated mucosa-like changes of flaps about 10 months after reconstruction. The clarity of conversation recovered favorably in most patients. However, the degree of recovery was generally related to the time after surgery. CONCLUSION: The radial forearm flap is a unique flap with specific characters that allowed for best available functional reconstruction of the oral cavity in terms of restoration of sensation, performance, and histological changes to adapt to the new oral environment.     

Recovery of sensation in the skin of non-innervated radial flaps after subfascial and suprafascial dissection

We compared the extent of recovery of sensation in 40 non-innervated radial free flaps, 20 of which had been raised subfascially and 20 suprafascially. We found no significant difference in sensory recovery between the two groups. The mean extent of sensory recovery was light touch (68%); sharp touch (84%); warm (29%) and cold (40%) temperature; and static (25%) and moving (31%) two-point discrimination. Nearly all the flaps responded to at least one stimulus (excluding two-point discrimination) and half of them to three or more. Sharp touch sensation in the flap was similar to that in the surrounding tissues and light touch was less sensitive. There was no dysaesthesia. Recovery was not related to sex, age, alcohol consumption, or site of reconstruction. Smoking and radiotherapy had a slight effect.