上臂外侧皮瓣在口腔颌面缺损修复中的应用

目的：探讨游离上臂外侧皮瓣（LAFF）在口腔颌面部恶性肿瘤根治术后软组织缺损修复重建中的应用价值。方法：自2012-01～2012-12,应用LAFF修复口腔颌面部肿瘤术后缺损的患者22例,观察记录皮瓣大小、制取时间、血管直径、吻合时间、组织瓣成活情况、手术修复成功率及术后效果,评价其优缺点。结果：皮瓣面积最大14 cm ×8 cm,最小6 cm ×4 cm。术后22例皮瓣均成活,未发生血管危象;并发症少,修复效果满意。结论：LAFF解剖位置恒定,制取简单,能满足常见口腔颌面部肿瘤术后软组织缺损修复。     

上臂外侧皮瓣移植修复舌缺损

目的 探讨上臂外侧皮瓣移植修复舌缺损的临床效果.方法 本组共10例舌鳞状细胞癌患者接受舌联合根治术同期上臂外侧皮瓣血管化移植修复术.术后随访评价再造舌形态、活动度、吞咽功能及语音功能.结果 10例患者术后均Ⅰ期愈合,上臂外侧皮瓣成活.术后随访平均16个月,无严重并发症,再造舌外形好,活动度满意,吞咽、语音功能接近正常,供区瘢痕隐蔽,临床疗效满意.结论 本组病例上臂外侧皮瓣移植舌再造的近期临床效果满意,远期疗效有待于进一步的随访和更深入的研究.     

游离延展上臂外侧皮瓣在口腔癌术后软组织缺损中的应用

目的 探讨游离延展上臂外侧皮瓣修复口腔癌术后软组织缺损的临床疗效。方法 2011年1月—2013年12月,应用游离延展上臂外侧皮瓣一期修复15例口腔癌扩大切除术造成的软组织缺损,术前应用多普勒血流探测仪测量桡侧副动脉无变异后,根据其走行以及术中软组织缺损的面积、形态设计皮瓣,皮瓣均越过肱骨外上髁,面积为4 cｍ×5 cm～11 cm×5 cm,血管蒂长约10cm。供区创面直接拉拢缝合。结果 14例皮瓣成活,１例因术后第2天发生动脉血管危象,抢救皮瓣无效,皮瓣坏死。术后随访12个月以上,所有患者均无肿瘤复发,肘部瘢痕较细,肘运动无障碍,未出现桡神经损伤引起的垂腕,２例患者供区局部有麻木感,６个月后症状减轻。术后患者语言功能恢复良好,鼻咽纤维镜检查吞咽顺利,腭咽闭合良好。所有患者ｌｉｋｅｒｔ评分法均为4～5分。结论 游离延展上臂外侧皮瓣解剖恒定、厚度适宜、血供可靠,是修复口腔癌术后软组织缺损的一种较好的选择。     

颈侧皮瓣修复口腔癌术后组织缺损

目的探讨以包含颈外静脉的颈侧皮瓣修复颊癌、舌癌、口底癌及牙龈癌术后软组织缺损的方法。方法根据软组织缺损面积,设计蒂部位于颌后区,包含真皮层、表浅肌肉腱膜系统(SMAS,Superficial Musculoaponeourotic System)层、颈浅筋膜层及颈深筋膜浅层,且包含颈外静脉的皮瓣,待口腔肿瘤切除后,经皮下隧道修复术区缺损。蒂部宽4.0cm,皮瓣最大面积14.0cm×4.0cm。结果临床应用20例,术后1例患者修复区的皮瓣完全坏死,逐步剪除坏死部分,最终血供较好的皮瓣基底部与口底创面愈合,2例皮瓣远端出现部分坏死,经换药去除坏死皮瓣后愈合。结论颈侧皮瓣手术方法简单,取瓣方便,血供较好,皮瓣长宽比较大,适合用于全身状况较差且组织缺损较小的患者。     

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.     

游离上臂外侧皮瓣在头颈肿瘤缺损修复中的应用

游离上臂外侧皮瓣 (ｌａｔｅｒａｌａｒｍｆｒｅｅｆｌａｐ ,ＬＡＦＦ)最早由我国的宋儒耀于 1982年介绍[1] ,美国的Ｋａｔｓａｒｏｓ1984年对该皮瓣作了详细的解剖学和临床应用研究[2 ] 。该皮瓣与前臂皮瓣同属筋膜皮瓣 ,两者具有许多共同的优点 :①皮瓣解剖恒定 ,制备简便 ;②皮瓣质地薄而富有弹性 ,特别适合于口内缺损的修复 ;③供区具有明确的感觉神经 ,可以制备成感觉皮瓣 ;④皮瓣可以携带一片骨组织而制备成骨皮复合瓣 ;⑤供区远离头颈部 ,用于头颈重建时可以实施“双组手术”。此外 ,与前臂皮瓣相比 ,ＬＡＦＦ还具有其独特的优点 :①…     

游离大腿前外侧皮瓣修复头颈部缺损的初步观察

目的探讨游离大腿前外侧皮瓣在头颈部缺损修复中的应用。方法回顾研究2002年1月至2006年1月完成的22例游离大腿前外侧皮瓣移植。分析采用组织瓣的设计、穿支血管的数目和类型、受区血管、血管吻合方式和技术、游离瓣成活情况及术后并发症，并分析有可能影响组织瓣成活的各种因素。结果22例中，皮瓣面积（7cm×5cm）～（16cm×8cm），平均11．1cm×6．9cm，除4块皮瓣携带2个穿支外，其余18块皮瓣均携带1个穿支。26个穿支中，20个为肌皮穿支，另外6个为隔皮穿支。1例游离瓣术后48h出现静脉危象，经抢救未成功后去除皮瓣。其余皮瓣术中、术后均未出现血管危象，并且全部成活。所有供区均直接拉拢缝合，除1例供区术后创口感染致二期愈合外，其余供区均一期愈合。结论游离大腿前外侧皮瓣克服了传统的前臂皮瓣和腹直肌皮瓣的缺点，在头颈部缺损的修复中具有较大的灵活性，值得进一步应用和观察。     

股前外侧穿支嵌合皮瓣修复口腔颌面肿瘤术后缺损

目的探讨游离股前外侧穿支嵌合皮瓣修复口腔颌面部肿瘤术后软组织复杂缺损的效果。方法选择2011年1月至2014年7月以游离股前外侧穿支皮瓣修复口腔颌面部肿瘤术后缺损患者39例。术前以彩色多普勒探测并标记供区血管,结合术中探查设计并制备嵌合皮瓣,并以此嵌合皮瓣修复口腔颌面部软组织缺损,术后观察口腔颌面部及供区形态和功能。结果 39例游离股前外侧穿支嵌合皮瓣全部成活,其中3例术后24 h内出现血管危象,经处理后皮瓣逐渐恢复正常。随访1~4年,口腔颌面部及供区形态及功能良好,6例患者术后3年内复发、死亡,其余患者均无复发。结论游离股前外侧穿支嵌合皮瓣修复口腔颌面肿瘤术后软组织复杂缺损效果良好,值得临床推广应用。     

股前外侧穿支皮瓣修复口腔癌术后缺损患者的生活质量评估

目的 评估应用游离股前外侧穿支皮瓣（ALTF）修复口腔颌面部恶性肿瘤切除术后组织缺损患者的生活质量（QOL）。方法 以2012年1月-2013年7月应用ALTF修复口腔颌面部恶性肿瘤切除术后组织缺损的32例患者为研究对象,应用口腔健康影响程度量表（OHIP-14）和简明健康状况调查问卷（SF-36）对患者术后12个月的QOL进行调查和评估。结果 SF-36问卷得分位于前3的项目是躯体疼痛、生理功能和躯体角色,得分分别是78.58±14.82、72.08±27.86和60.00±42.63;得分较低的是情感角色（41.67±39.62）、心理健康（50.75±13.07）和健康变化（54.17±21.75）。分析OHIP-14量表得分,恢复较好的项目是社交障碍和残障,得分分别为34.50±11.32和36.04±12.05;恢复较差的项目是生理性疼痛和心理不适,得分分别为73.50±18.96和60.17±25.66。结论 采用ALTF修复口腔颌面部恶性肿瘤切除术后组织缺损,能够恢复患者外形、语言和咀嚼功能的基本需求,提高患者的QOL。     

The free revascularized lateral upper arm flap in maxillofacial reconstruction following ablative tumour surgery.

The lateral arm flap is well established in microvascular reconstructive surgery for covering small and moderate-sized defects both of the extremities and in the head and neck region. In the last 3 years 25 patients underwent a lateral upper arm flap for primary repair of tumour related defects of the tongue (n = 10), floor of the mouth (n = 7), mandible (n = 4), inner cheek (n = 2), oropharynx (n = 1) and lower lip (n = 1). Defects extended from the anterior floor of the mouth to the oral tongue in three cases and in four cases the defect reached the pharyngeal tongue. Two flaps had neurovascular anastomoses between the posterior cutaneous nerve of the arm and the lingual nerve. In all patients the donor defect was closed primarily. Twenty four lateral upper arm flaps healed uneventfully although six patients developed severe alcoholic delirium. One flap was lost on the fourth postoperative day due to venous insufficiency. There were no significant complications at the donor site. At the time of this report 16 patients were taking a normal diet while nine patients were taking pureed food. Among the advantages of this flap are anatomically reliable vascular supply, its good aesthetic quality, and position of the donor site. Furthermore the posterior radial collateral artery is a nonessential vessel of the arm. The flap is also potentially sensate. Among the disadvantages are smaller vessels for microvascular anastomoses. In conclusion, we believe that for repair of moderate-sized defects of the maxillofacial area the lateral upper arm flap can be recommended as the first choice.     

The lateral upper arm free flap for intraoral reconstruction

Twenty-three consecutive patients who were reconstructed with a lateral upper arm free flap (LUFF) were examined especially concerning functional and morphological results at the recipient and donor sites. There were 22 intraoral and one upper oesophageal reconstruction after radical laryngectomy. The LUFF rendered good functional and esthetic results except for one case of complete and one case of incomplete flap necrosis due to vascular insufficiency of the supplying vessel of the neck. There was some sensory deficit of the donor site (n=10), but no radial nerve injury or conspicuous scarring. Recipient site dehiscence occurred in two cases and a temporary orocervical fistula was seen in one case. Oral function was maintained due to the thin and pliable flap. Excellent flap adaptation to the adjacent tissue was obtained in eight cases of complete loss of lingual attached gingiva in the molar region and in four cases of loss of buccal attached gingiva. The success and functional results of LUFF were comparable to the results of 14 cases in which radial forearm free flaps (RFFF) were used. Although the length of the pedicle and the diameter of the vessels in LUFF are smaller than in RFFF, neither pedicle length nor vessel diameter proved to be a problem. Extent of scarring and risk of vascular compromise proved to be less as compared to RFFF. LUFF is, therefore, the flap of choice for intraoral soft tissue reconstruction and it is advised to reserve RFFF for cases in which LUFF fails.     

逆行面动脉-颏下动脉岛状肌皮瓣修复口腔颌面部缺损的探讨

目的评价逆行面动脉-颏下动脉岛状肌皮瓣修复口腔颌面部缺损的可行性。方法用逆行面动脉-颏下动脉岛状肌皮瓣修复18例恶性肿瘤切除术后口腔颌面部缺损。男性11例，女性7例，年龄28～90岁。舌鳞癌7例、颊黏膜鳞癌4例、腭鳞癌3例、口咽癌和面部皮肤基底细胞癌各2例。肌皮瓣面积最小为4．0cm×12．0cm，最大为5．0cm×15．0cm。结果17例肌皮瓣存活，1例缺血坏死。肌皮瓣受区外观满意、功能恢复良好，供区瘢痕隐蔽。经术后6～18个月，平均11．8个月随访，1例术后10个月对侧颈部淋巴结转移。结论逆行面动脉-颏下动脉岛状肌皮瓣是口腔颌面部中型缺损的理想修复材料。     

Swallowing and speech function after intraoral soft tissue reconstruction with lateral upper arm free flap and radial forearm free flap

Swallowing, speech, and morbidity were assessed postoperatively in 25 patients, 18 of whom had had intraoral defects reconstructed by lateral upper arm free flaps (LUFF) and 7 by radial forearm free flaps (RFFF). Video fluoroscopy was used to assess swallowing, the Freiburger audiometric test to assess speech; and measurement of arm circumference to assess donor site morbidity. A questionnaire was used to evaluate swallowing, speech, and donor site morbidity subjectively.The degree of impairment in swallowing depended on the site of resection. Anterior and posterior resections affected swallowing more than lateral resections. Anterior resection and the use of LUFFs reduced intelligibility. There was no significant difference in impairment between LUFF and RFFF. We conclude that the LUFFs are superior to RFFFs because they can be closed primary and the incidence of donor site morbidity is slight.     

游离股后内侧皮瓣在口腔颌面部缺损修复重建中的应用初探

为探讨游离股后内侧皮瓣在口腔颌面部缺损修复重建中的应用,本研究纳入2019年1月至 2020年1月就诊于郑州大学第一附属医院口腔颌面外科的口腔癌患者23例,男性13例,女性10例,年龄（54.5±9.7）岁（33~72岁）。23例患者在口腔癌切除同期均采用股后内侧皮瓣修复口腔颌面缺损。记录皮瓣供区穿支血管数目和类型,切...     

前臂皮瓣修复舌癌术后舌缺损患者的生存质量评价

目的 分析评价前臂皮瓣修复舌鳞状细胞癌术后舌缺损患者的术后生存质量.方法 应用美国华盛顿大学生存质量问卷(University of Washington head and neck quality-of-life questionnaire,UW-QOL)对112例舌鳞状细胞癌术后前臂皮瓣修复舌缺损患者行生存质量评价,并对不同程度、不同部位舌缺损患者的术后生存质量进行对比分析.结果 112例患者的总体生存质量得分为959.6分,达到总分的80%(960/1200);舌缺损≤1/2全舌(＞1/3全舌)患者的总体生存质量得分(979.8分)明显高于舌缺损＞1/2全舌患者(901.7分),其中语言功能的恢复存在明显差异,两组患者的平均得分分别为71.1和58.6分(P＜0.05);缺损未涉及舌根和涉及舌根的患者术后生存质量得分分别为981.6和950.0分,差异无统计学意义(P＞0.05).结论 前臂皮瓣是舌缺损重建的良好选择,修复舌根部缺损也能获得良好治疗效果;前臂皮瓣更适合用于≤1/2全舌(＞1/3全舌)的舌缺损重建.

Abstract：

Objective To evaluate the quality-of-life outcomes in patients with tongue cancer following reconstruction with free forearm flap. Methods Quality-of-life (QOL) outcomes of 112 patients of tongue reconstruction with free forearm flap were assessed using University of Washington head and neck QOL questionnaire (UW-QOL). The QOL outcomes of the patients with different defect range and site were also compared. Results The overall mean QOL scores of the 112 patients was 959. 6, which reached about 80% (960/1200)of the overall score. The QOL scores of the patients with defects not more than 1/2 tongue ( more than 1/3 tongue) were significantly higher than those with defects more than 1/2 tongue ( P ＜0.05 ).There was no significant difference between the QOL scores of the patients with and without tongue base defect (P ＞ 0.05 ). Conclusions Free forearm flap is a good choice for tongue reconstruction and more suitable for the reconstruction of the defects not more than 1/2 tongue ( more than 1/3 tongue).     

颞浅动脉及静脉作为头颈部游离瓣移植受区血管的可靠性探讨

目的 探讨颞浅动、静脉作为头颈部游离瓣移植受区血管的可靠性和应用价值.方法2001年5月至2008年6月采用颞部血管作为受区血管的头颈部游离瓣移植25例,分析游离瓣的受区血管、术中及术后的血管危象及游离瓣的成活情况.结果 25例患者中,23块游离瓣采用颞浅静脉作为受区静脉,2例采用颞深静脉作为受区静脉,全部游离瓣均采用颞浅动脉作为受区动脉.全部游离瓣术后均未出现血管危象,游离瓣均获成活.结论本组结果表明,颞浅动、静脉是头颈部游离瓣移植可靠的受区血管.