颊部岛状皮瓣在口腔软组织缺损修复中的临床应用

目的 应用颊部岛状皮瓣修复口腔肿瘤根治性切除术后软组织缺损,并对其临床效果进行评定。方法 选择2006.07—2011.07口腔癌症患者23例,其中男13例,女10例,全部行病灶根治切除及颈淋巴清扫术,同期应用颊部岛状皮瓣修复舌、口底及其邻近组织缺损,皮瓣面积最大为10.4 cm×5.0 cm,最小为7.5 cm×3.5 cm,供区伤口直接拉拢缝合。术后观察皮瓣的成活、修复区外形及口腔与舌功能的恢复情况。结果 23例皮瓣均完全成活,创口一期愈合,术后外形满意,功能恢复良好,无明显面部畸形。结论 颊部岛状皮瓣是修复口腔内软组织缺损较为理想的组织瓣。     

改良胸大肌岛状肌皮瓣在舌癌连续整块切除术后缺损修复中的应用

目的 探讨改良后的胸大肌岛状肌皮瓣修复舌癌连续整块切除术后缺损的效果。方法 2005年1月—2010年6月,对23例舌癌患者采用改良后的胸大肌岛状肌皮瓣修复舌癌连续整块切除术后缺损;观察术后皮瓣成活情况及伤口愈合情况,并随访评价再造舌形态、功能,皮瓣供区功能及皮瓣对术后放疗的耐受性。结果 23例病例肌皮瓣全部存活;再造舌外形满意,全部病例半年内吞咽、语言功能基本恢复;供区瘢痕减少,无功能障碍,放疗患者未出现皮瓣坏死。结论 改良的胸大肌岛状肌皮瓣,安全可靠,修复效果好,是修复舌癌连续整块切除后缺损的理想皮瓣。     

腹壁下动脉穿支皮瓣在全舌癌缺损修复中的应用效果评价

目的: 评价游离腹壁下动脉穿支皮瓣（deep inferior epigastric perforator,DIEP）用于舌癌术后全舌缺损修复的效果。方法: 2018年1月—2018年7月应用游离DIEP修复13例舌癌患者,手术缺损部位均为全舌或近全舌缺损。术中将腹壁下动脉与甲状腺上动脉或面动脉吻合,伴行静脉与颈外静脉或颈内静脉属支吻合。结果: l3例DIEP皮瓣均修复成功,皮瓣外观满意。术后随访舌形态良好,功能满意。供区直接闭合,其中1例患者皮瓣供区出现感染,经换药后愈合。所有腹部伤口均为线性瘢痕,腹直肌功能未受明显影响,未发现腹壁疝和腹壁隆起等手术并发症。结论: 腹壁下动脉穿支皮瓣组织量丰富、血供可靠、质地柔软,再造舌外形及功能良好,且供区保留了腹直肌和前鞘,损伤小,将供区并发症降到最低限度,是舌癌术后全舌缺损修复新的可靠技术。     

对侧面动脉蒂鼻唇沟岛状瓣修复舌癌术后缺损6例临床研究

目的    探讨使用对侧面动脉蒂鼻唇沟岛状瓣修复舌癌术后缺损的临床效果。方法    对2013年1月到2014年6月广东省高州市人民医院口腔科收治的6例舌癌切除术后组织缺损患者,应用对侧面动脉蒂鼻唇沟岛状瓣进行修复。记录术后皮瓣血运、愈合情况,并对患者口腔功能进行8～18个月的随访。结果    6例患者皮瓣愈合良好,术后随访未出现严重并发症,无肿瘤复发,再造舌外形及活动度满意, 语音、吞咽功能接近正常。结论    对侧面动脉蒂鼻唇沟岛状瓣修复舌癌术后缺损效果良好,因术区未涉及肿瘤引流淋巴结,可用于口腔颌面部恶性肿瘤术后缺损的修复。     

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。     

锁骨上动脉岛状瓣的解剖研究及其修复舌缺损的初步报告

目的 为临床应用锁骨上动脉岛状瓣提供解剖学依据,评价其修复舌部缺损的可靠性.方法 用成人尸体10例(20侧)经锁骨下动脉灌注氧化铅-明胶溶液的标本,观测颈横动脉和锁骨上动脉的分支、起始位置、行程、长度和管径,观察其静脉回流情况.用锁骨上动脉岛状瓣修复4例舌癌切除术后缺损,通过观察舌部形态和功能恢复及供区并发症等,评价修复效果.结果 颈横动脉由甲状颈干或锁骨下动脉分支而来,在锁骨中1/3上方分为深支和浅支.锁骨上动脉由颈横动脉浅支发出.颈横动脉起点至锁骨上动脉起点距离约4.3 cm,锁骨上动脉起点至其分支穿深筋膜点的距离约3.6 cm.颈横动脉起点处血管外径约2.7 mm,锁骨上动脉起点处血管外径约1.1 mm.两条锁骨上动脉伴行静脉分别回流入颈横静脉和颈外静脉.4例用于修复舌部缺损的皮瓣中,3例全部成活,1例小部分皮岛坏死,肩功能运动不受影响.结论 以锁骨上动脉为营养血管的锁骨上动脉岛状瓣带蒂转移适于修复口腔颌面颈部组织缺损,也可以颈横动脉为吻合血管制作游离皮瓣.     

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。     

面动脉-颏下动脉岛状皮瓣修复半舌缺损

目的:探讨面动脉-颏下动脉岛状肌皮瓣修复舌癌术后缺损的效果。方法:2007-01—2008-01收治舌鳞癌患者35例,其中男20例,女15例。全部采用面动脉-颏下动脉岛状肌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6.0 cm×4.0 cm,最大12.0 cm×5.0 cm。结果:面动脉-颏下动脉岛状肌皮瓣存活率为94.29%(33/35),患者语言、吞咽功能良好,面部外形满意。2例术后淋巴结转移复发,其中1例治疗后存活,1例死亡。结论:面动脉-颏下动脉岛状肌皮瓣安全、操作简单快速、成活率高,适合同期修复舌癌术后半舌缺损。     

颏下岛状皮瓣在颊癌缺损修复中的临床应用

目的探讨颏下岛状皮瓣在修复颊癌缺损中的应用。方法对7例颊癌术后的缺损的患者,同期行颏下岛状皮瓣修复。结果随访6～36个月,7例皮瓣均完全成活,未发生感染、坏死等并发症,无下颌缘支面瘫症状,皮瓣色泽红润,言语功能恢复良好。结论颏下岛状皮瓣血供恒定,制备简单,供区并发症少,成活率高,是修复颊癌术后组织缺损较理想的皮瓣。     

颏下岛状皮瓣在修复舌癌术后缺损中的临床应用

目的:探讨颏下岛状皮瓣在修复舌癌术后组织缺损中的临床应用价值。方法:利用5具经10%甲醛溶液固定的国人成人男性标本,对颏下动脉相关解剖进行观测,并结合我院2005-09—2008-06使用颏下岛状皮瓣修复的9例舌癌患者进行临床回顾性分析。结果:颏下动脉走行恒定。9例颏下岛状皮瓣均成活,2例皮瓣远端表面部分坏死。修复后的舌黏膜表面光滑,运动受限不明显,吞咽功能良好。结论:颏下岛状皮瓣供血血管恒定,制备简单,成活率高,供区并发症少,且能够耐受放疗,是修复舌癌术后组织缺损较理想的皮瓣。     

带血管蒂游离组织瓣同期修复舌癌术后缺损及临床评价

目的 评价带血管蒂游离组织瓣修复舌嶙癌术后缺损的外形及功能恢复效果。方法32例舌癌患者进行根治术的同期．分别采用带血管蒂的前臂游离皮瓣、足背游离皮瓣进行修复，术后观察组织瓣成活状况．舌功能和外形，并评价表评价患者的语言和（或）吞咽的功能恢复情况.结果 32例中,31例成活,成活率93.9%,术后观察见舌形态良好,语言,咀嚼,吞咽,证食等功能恢复至正常或接近正常,未发现复发及死亡病倒.结论 舌癌根治术同期选择带血管蒂游离组织瓣修复,可以较好地恢复舌的功能,并可能提高生存率.     

腓肠内侧动脉穿支皮瓣修复舌缺损的疗效评价

目的: 研究运用游离腓肠内侧动脉穿支皮瓣修复半舌缺损的可行性与临床效果,为腓肠内侧动脉穿支皮瓣用于舌部缺损修复提供依据。方法: 选取9例舌癌患者,术前利用CT血管造影（CTA）技术对腓肠内侧动脉穿支进行定位,术中运用腓肠内侧动脉穿支皮瓣行半舌缺损修复。对成功应用该皮瓣进行舌重建的8例患者,术后1个月以及3个月进行随访,评价舌部功能及供区状况。结果: 腓肠内侧动脉穿支皮瓣血管蒂长,管径与颈部血管匹配,对供区损伤小,腓肠内侧动脉穿支皮瓣重建舌丰满,术后语音及咀嚼功能良好,舌部感觉功能欠佳。供区功能良好,仅留存线性瘢痕,供区未见明显并发症。结论: 游离腓肠内侧动脉穿支皮瓣可成为舌缺损修复重建的另一种选择,其供区隐蔽,损伤小,皮瓣厚度适合舌部缺损修复,术后患者语音及咀嚼功能恢复良好。     

上臂外侧皮瓣在口腔癌术后缺损修复中的初步应用

目的 探讨上臂外侧皮瓣（LAFF）在口腔软组织缺损修复重建中的应用价值。方法用上臂外侧皮瓣即刻修复口腔鳞癌根治术后的继发缺损10例。结果 除1例皮瓣坏死外，其余9例组织瓣全部成活，口腔组织形态和功能恢复满意。7例患者供区有麻木感，无其他并发症。结论 与前臂桡侧皮瓣相比，由于LAFF优点诸多，在口腔中小型软组织缺损的修复中，LAFF是一种可选择的优秀皮瓣。     

应用游离股前外侧皮瓣重建舌癌术后组织缺损

目的:探讨应用游离股前外侧肌皮瓣修复舌癌术后组织缺损的临床效果。方法 :2008-01—2011-01应用股前外侧肌皮瓣修复舌癌术后组织缺损19例,其中男性11例,女性8例,年龄29岁至65岁,平均年龄50岁。病理类型:高分化鳞癌15例,中分化鳞癌4例。按UICC标准TNM分期:T2N0M0 5例,T3N0M0 8例,T3N1M0 4例,T4N1M0 2例;皮瓣大小为(8 cm×5 cm)^{(15 cm×7 cm)}。结果:19例股前外侧肌皮瓣全部成活,全部病例面颈部创面及大腿皮瓣供区均一期愈合。所有患者舌部缺损修复形态良好,患者语音、咀嚼、吞咽功能恢复良好,手术前后对比,未见明显颌面部畸形。术后随访1(15 cm×7 cm)。结果:19例股前外侧肌皮瓣全部成活,全部病例面颈部创面及大腿皮瓣供区均一期愈合。所有患者舌部缺损修复形态良好,患者语音、咀嚼、吞咽功能恢复良好,手术前后对比,未见明显颌面部畸形。术后随访1³年,1例患者术后1年出现对侧颈部淋巴结及全身骨转移并死亡,余患者未见转移和复发。结论:股前外侧皮瓣组织量丰富,适用于口腔颌面部癌肿术后组织缺损修复及器官功能恢复;因其供区隐蔽,对供区影响小,尤其适合年轻女性患者。     

Novel modification of infrahyoid myocutaneous flap for the reconstruction of oral cavity defects

This study was intended to describe the technique used and the results obtained with the modification of the infrahyoid flap (IHF) for the reconstruction of oral tongue defects following resection for advanced squamous cell carcinoma (SCC). Patients with oral tongue defects following ablation for T2 to T4a SCC had reconstructions using a modified infrahyoid flap. Demographic data, tumour characteristics, and the complications were evaluated for each patient. We observed no complications regarding the healing process of the donor site or success of the flap in 49 (of 55) patients. None of the flaps had massive oedema or venous congestion in the postoperative period. Six patients experienced flap-related complications of which five had partial skin paddle necrosis, but eventually their flaps recovered and re-epithelialised without any further intervention. However, total flap necrosis was seen in one patient in whom a pectoralis major flap was used for the defect reconstruction following revision surgery. History of previous radiotherapy to the neck (p = 0.003), tumour stage (p = 0.017), and metastasis to cervical lymph nodes (p = 0.004) were associated with higher prevalence of partial or total flap necrosis. The modified infrahyoid flap is a reliable, quick, and simple procedure with a reasonable cost that makes it a valuable option for the reconstruction of the oropharynx and oral cavity with minimal donor site morbidity and good outcomes. It seems the modified IHF is a valid surgical procedure that may be considered in selected patients undergoing reconstruction of oncological oral tongue defects with fewer complications.     

前臂皮瓣和股前外侧皮瓣修复对舌鳞癌术后缺损老年患者生活质量的影响

目的 比较前臂皮瓣和股前外侧皮瓣修复对舌鳞状细胞癌术后缺损老年患者生活质量的影响。方法 对我院口腔科就诊的行股前外侧皮瓣或前臂皮瓣修复舌鳞状细胞癌术后缺损的129例老年患者临床资料行回顾性分析,其中股前外侧皮瓣组81例,前臂皮瓣组48例。应用华盛顿大学生命质量问卷（The University of Washington Quality of Life,UW-QOL）和口腔健康影响程度量表（the 14-item Oral Health Impact Profile questionnaires,OHIP-14）调查并比较患者术后 6、12个月的生活质量差异。结果 两组患者肿瘤切除方式差异具有统计学意义（P<0.05）。组内不同时间点比较,生活质量评价所有指标均得到显著改善。UW-QOL结果显示,两组术后6和12个月总分比较差异均无统计学意义（P>0.05）。OHIP-14结果显示,术后6个月股前外侧皮瓣组总分显著小于前臂皮瓣组（P<0.05）,术后12个月总分比较差异无统计学意义（P>0.05）。结论 两组舌鳞癌老年患者术后 12个月生活质量无显著差异,建议舌部分切除时选择前臂皮瓣修复,舌全切除时选择股前外侧皮瓣修复。     

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.     

Comparison of islanded facial artery myomucosal flap with fasciocutaneous free flaps in the reconstruction of lateral oral tongue defects

The aim of this study was to determine whether the islanded facial artery myomucosal flap (iFAMM) is a good alternative to fasciocutaneous free flaps (FCFF) in the reconstruction of lateral oral tongue defects. This was a retrospective study of 40 patients with oral tongue cancers (lateral lesions not >4 cm) operated on between August 2014 and March 2017, who underwent primary reconstruction with either an iFAMM or FCFF. The two groups were compared with respect to intraoperative time, total intensive care unit (ICU) and hospital stay, complications, speech, swallowing, aesthetics, donor site morbidity, and economic feasibility. Patients who had an iFAMM had a reduced operating time, duration of ICU stay, and length of hospitalization; this flap was also more economically feasible. Better aesthetics and less donor site morbidity were also seen. The iFAMM is an alternative to FCFF in the reconstruction of lateral oral tongue defects, as it is less technically demanding, has good aesthetic outcomes, and is more economical, with acceptable donor site morbidity.     

游离腓肠内侧动脉穿支皮瓣修复头颈部缺损的初步研究

目的 探讨游离腓肠内侧动脉穿支皮瓣在头颈部缺损修复中的应用.方法 2010年4月至2011年1月16例患者头颈部肿瘤切除后拟用游离腓肠内侧动脉穿支皮瓣修复组织缺损,术前采用超声多普勒血流仪或彩色多普勒超声检测穿支血管,设计皮瓣,术中记录皮瓣大小、穿支血管的数目和血管蒂长度,术后观察游离瓣成活情况,随访记录供区愈合情况及评价术后并发症.结果 最终完成游离腓肠内侧动脉穿支皮瓣修复16例,15例皮瓣术后成活,1例术后因静脉危象手术探查后皮瓣部分存活.供区15例直接缝合,1例植皮.15例供区Ⅰ期愈合,1例因术后供区肌肉坏死行清创手术后愈合.14例术后随访3～ 12个月,所有患者供区除因瘢痕致远端皮肤触觉异常外,远期无明显功能障碍.结论 游离腓肠内侧动脉穿支皮瓣供区并发症轻微,适用头颈部中小型缺损修复.